Provider Demographics
NPI:1114387735
Name:ADVANCED INPATIENT MEDICINE-LTAC PC
Entity Type:Organization
Organization Name:ADVANCED INPATIENT MEDICINE-LTAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAONE GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPC
Authorized Official - Phone:570-241-4715
Mailing Address - Street 1:150 ICE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9654
Mailing Address - Country:US
Mailing Address - Phone:570-647-8990
Mailing Address - Fax:570-261-2015
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-340-5079
Practice Address - Fax:570-340-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty