Old Forge Wellness LLC
Organization Active NPI Internal Medicine Physician · Old Forge, PA
NPI 1649045451 · NPPES record last updated Nov 21, 2023
Key facts
- NPI
- 1649045451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- OLD FORGE WELLNESS LLC
- Practice address
- 821 S Main St Ste 1
Old Forge, PA 18518-1497 - Phone
- (570) 774-4171
- Fax
- (570) 457-3220
- NPI assigned
- Nov 21, 2023
- Organization subpart
- No
Authorized official
- Name
- Lori Ann Slocum, PHARMD
- Title
- Ceo
- Phone
- (570) 774-4171
Practitioners 2
-
Michael A Jalowiec, D.O.
-
Lori Ann Slocum, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231229000065 | PA | Part B Supplier - Clinic/Group Practice | 8527418847 |
Receives reassigned benefits from 1 practitioner Practice locations: Old Forge, PA |
National Provider Directory
Locations
821 S Main St
Ste 1
Old Forge, PA 18518
Phone (570) 457-3200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
821 S Main St Ste 1
Old Forge, PA 18518-1497
Mailing address
821 S Main St Ste 1
Old Forge, PA 18518-1497
Phone (570) 774-4171
Other providers in Old Forge, PA
- Robert James Notari
- Thomas Michael Nowakowski Jr.
- Old Forge Ambulance & Rescue Association
- Old Forge Chiropractic & Rehabilitation, P.C.
- Old Forge School District
- Sharon Palushock
- Stephen Robert Paranich
- Lisa Ann Pastore
- Peace of Mind, Nepa, LLC
- Nicholas E Pecuch
All providers in Old Forge, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.