Organization
INTEGRATED MEDICAL GROUP P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYER (BILLING MANAGER)
(570) 622-5455
Entity
Organization
Contact information
Practice address
82 TUNNEL RD, POTTSVILLE, PA 17901-3869
(570) 622-5455
(570) 622-5493
Mailing address
82 TUNNEL RD, POTTSVILLE, PA 17901-3869
(570) 622-5455
(570) 622-5493
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
291U00000X
Clinical Medical Laboratory
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100775174
—
PA
Enumeration date
04/11/2006
Last updated
02/10/2016
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