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General NPI Number Information
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NPI Number | 1295000982
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Entity Type | Organization
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Legal Business Name | PIONEER CITY URGENT CARE LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 267 BROOKLYN ST SUITE B
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City | CARBONDALE
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State | PA
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Zip | 18407-2836
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Country | US
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Telephone | 570-282-4100
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Fax | 570-282-4200
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Provider Business Mailing Address
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Address Line | PO BOX 1644
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City | KINGSTON
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State | PA
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Zip | 18704-0644
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Country | US
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Telephone | 570-282-4100
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Fax | 570-282-4200
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROMAN MATLAGA
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Credential | M.D.
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Telephone | 570-282-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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