Provider Demographics
NPI:1730230871
Name:TIOGA COUNTY
Entity type:Organization
Organization Name:TIOGA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ACCOUNTING SUPERVISO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:YURICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-687-8573
Mailing Address - Street 1:1062 RT 38
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-3209
Mailing Address - Country:US
Mailing Address - Phone:607-687-8600
Mailing Address - Fax:
Practice Address - Street 1:1062 RT 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-3209
Practice Address - Country:US
Practice Address - Phone:607-687-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIOGA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5324200R251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356294Medicaid