MEDICARE: AMBULATORY INTERNAL MEDICINE CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD056295L	PA

General Provider Information

NPI Number	:	1730482225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY INTERNAL MEDICINE CLINIC, PC

Provider Business Mailing Address
First Line	:	216 N RIVER ST
Second Line	:	SUITE # 650
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2532
Country	:	US
Telephone Number	:	570-270-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 N RIVER ST
Second Line	:	SUITE # 650
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2532
Country	:	US
Telephone Number	:	570-270-7200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADNAN SABA
Credential	:	M.D
Telephone Number	:	570-270-7200

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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