Intermountain Medical Group, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

000495 Issued in PA

Legal business name

INTERMOUNTAIN MEDICAL GROUP, INC

Practice address

610 Wyoming Ave
Kingston, PA 18704-3702

Phone

(570) 288-5441

Fax

(570) 288-5842

NPI assigned

Nov 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Czwalina, D.O.

Title

Laboratory Director

Phone

(570) 288-5441

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Accu Clinical Laboratory Doing business as

Locations (25 of 27)

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laurie Brogan, PT, DPT, CEEAA, GCS

  • Physical Therapist
  • Dallas, PA
  • NPI 1912460890
  NPD (past)
• Marla G Campbell, PT

  • Physical Therapist
  • Forty Fort, PA
  • NPI 1831215854
  NPD (past)
• Joseph P Chollak Jr., MD

  • Family Medicine Physician
  • Kingston, PA
  • NPI 1932176435
  NPD (past)
• Roger F Crake, MD

  • Surgery Physician
  • Berwick, PA
  • NPI 1295733418
  NPD (past)
• Kristen Digwood

  • Physical Therapist
  • Wilkes Barre, PA
  • NPI 1093825374
  NPD (past)
• Kathleen Anne Garrity, R.D.

  • Registered Dietitian
  • Forty Fort, PA
  • NPI 1548518954
  NPD (past)
• Kenneth M Granahan, MPT

  • Physical Therapist
  • Forty Fort, PA
  • NPI 1710929666
  NPD (past)
• Madison Macknosky, PA-C

  • Physician Assistant
  • Scott Township, PA
  • NPI 1679434732
  NPD (past)
• Riley Claire McLaughlin, PA

  • Physician Assistant
  • Shavertown, PA
  • NPI 1598638934
  NPD (past)
• David E Owens, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Kingston, PA
  • NPI 1669458808
  NPD (past)
• Joanne M Petro, PA C

  • Physician Assistant
  • Mountain Top, PA
  • NPI 1265486195
  NPD (past)
• Mark C. Pyles, MD

  • Surgery Physician
  • Berwick, PA
  • NPI 1154328110
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1932271624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702",
            "telephone_number": "570-288-5441",
            "fax_number": "570-288-5842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702",
            "telephone_number": "570-288-5441",
            "fax_number": "570-288-5842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "CZWALINA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "570-288-5441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "000495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "317305",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Accu Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Immediate Care Medical Center,Inc
• Infantino Chiropractic
• Diane C Insalaco
• Institute for Human Resources and Services, Inc.
• Intermountain Medical Group, Inc
• Daniela Ionescu, DDS
• James M Jiunta DO Inc
• James R McDermott DC PC
• Lauren Ann Janoski
• Kimberly Janosky, PT

• All providers in Kingston, PA
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.