Provider Demographics
NPI:1730429697
Name:TIOGA HEALTH CARE PROVIDERS, INC 13
Entity type:Organization
Organization Name:TIOGA HEALTH CARE PROVIDERS, INC 13
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-724-2325
Mailing Address - Street 1:9 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1117
Mailing Address - Country:US
Mailing Address - Phone:570-124-2325
Mailing Address - Fax:570-724-5855
Practice Address - Street 1:9 WATER ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1117
Practice Address - Country:US
Practice Address - Phone:570-124-2325
Practice Address - Fax:570-724-5855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009267L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty