Organization
INTEGRATED MEDICAL GROUP P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI BURNS (HR)
(570) 622-5455
Entity
Organization
Contact information
Practice address
48 TUNNEL RD, SUITE 203, POTTSVILLE, PA 17901-3875
(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
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100775174
—
PA
Enumeration date
04/13/2006
Last updated
11/19/2024
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