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General NPI Number Information
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NPI Number | 1154581361
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Entity Type | Organization
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Legal Business Name | QUALITY CARE INTERNAL MEDICINE
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 195 PLEASANT ST SUITE 5
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City | BRADFORD
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State | PA
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Zip | 16701-1081
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Country | US
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Telephone | 814-363-9540
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Fax | 814-363-9562
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Provider Business Mailing Address
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Address Line | 195 PLEASANT ST SUITE 5
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City | BRADFORD
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State | PA
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Zip | 16701-1081
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Country | US
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Telephone | 814-363-9540
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Fax | 814-363-9562
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GREGORY ANDREW AMBUSKE
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Credential | D.O.
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Telephone | 814-363-9540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OS013889
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License Number State | PA
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