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General NPI Number Information
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NPI Number | 1841469954
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Entity Type | Organization
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Legal Business Name | CLINICAL OUTCOMES GROUP, INC.
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 1 S 2ND ST FL 1
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City | POTTSVILLE
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State | PA
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Zip | 17901-3088
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Country | US
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Telephone | 570-628-6990
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Fax | 570-628-5899
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Provider Business Mailing Address
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Address Line | 1 S 2ND ST FL 1
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City | POTTSVILLE
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State | PA
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Zip | 17901-3088
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Country | US
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Telephone | 570-628-6990
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Fax | 570-628-5899
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MRS. ALICIA FLEISCHUT
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Credential | MA
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Telephone | 570-628-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW125918
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | PC000151
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PC000151
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License Number State | PA
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