Tioga Healthcare Providers Inc-6

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

TIOGA HEALTHCARE PROVIDERS INC-6

Practice address

1 Main St
Wellsboro, PA 16901-1601

Phone

(570) 723-0716

Fax

(570) 723-0638

NPI assigned

Jan 31, 2006

Organization subpart

Yes

Parent organization

LAUREL HEALTH SYSTEMSAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley Mudge, DO

Title

Physician

Phone

(570) 723-0716

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Canyon Surgical Associates Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1619948288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169010191",
            "telephone_number": "570-723-0716",
            "fax_number": "570-723-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011601",
            "telephone_number": "570-723-0716",
            "fax_number": "570-723-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA HEALTHCARE PROVIDERS INC-6",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAUREL HEALTH SYSTEMS",
        "enumeration_date": "2006-01-31",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "MUDGE",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "570-723-0716",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1626712",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "DC0711",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tioga Health Care Providers, Inc.
• Tioga Health Care Providers, Inc.
• Tioga Health Care Providers, Inc. 1
• Tioga Health Care Providers, Inc. 5
• Tioga Healthcare Providers 8, Inc
• Tiogacounty Dept of Human Services
• Stacy Tom
• Judith Tubbs, CRNP
• Twin Tier Management Corp Inc
• Hannah Upham, LSW

• Surgery Physician in Wellsboro, PA
• Providers in Wellsboro, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.