Provider Demographics
NPI:1881900587
Name:TIOGA HEALTH CARE PROVIDERS 12
Entity type:Organization
Organization Name:TIOGA HEALTH CARE PROVIDERS 12
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-724-3636
Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:SUITE U3
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-3636
Mailing Address - Fax:570-724-3326
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:SUITE U3
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-3636
Practice Address - Fax:570-724-3326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-19
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA190480Medicare PIN