Organization
INTERMOUNTAIN MEDICAL GROUP, INC
Active
Other names
Accu Clinical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CZWALINA D.O. (LABORATORY DIRECTOR)
(570) 288-5441
Entity
Organization
Contact information
Practice address
610 WYOMING AVE, KINGSTON, PA 18704-3702
(570) 288-5441
(570) 288-5842
Mailing address
610 WYOMING AVE, KINGSTON, PA 18704-3702
(570) 288-5441
(570) 288-5842
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
000495
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
317305
BLUE SHIELD
PA
Enumeration date
11/15/2006
Last updated
07/13/2011
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