Healthcare Provider Details

I. General information

NPI: 1316942345
Provider Name (Legal Business Name): IMMEDIATE CARE MEDICAL CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 PIERCE ST
KINGSTON PA
18704-5120
US

IV. Provider business mailing address

349 PIERCE ST
KINGSTON PA
18704-5120
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-2300
  • Fax: 570-288-2298
Mailing address:
  • Phone: 570-288-2300
  • Fax: 570-288-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-002974-L
License Number StatePA

VIII. Authorized Official

Name: ANTHONY GIARDINA
Title or Position: DOCTOR
Credential: DO
Phone: 570-288-2300