Provider Demographics
NPI:1154834927
Name:OPEN ARMS INTERNAL MEDICINE & PEDIATRICS, PC
Entity Type:Organization
Organization Name:OPEN ARMS INTERNAL MEDICINE & PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GOMBOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-244-1877
Mailing Address - Street 1:5271 STATE ROUTE 973 E
Mailing Address - Street 2:
Mailing Address - City:COGAN STATION
Mailing Address - State:PA
Mailing Address - Zip Code:17728-8500
Mailing Address - Country:US
Mailing Address - Phone:570-244-1877
Mailing Address - Fax:
Practice Address - Street 1:3155 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1032
Practice Address - Country:US
Practice Address - Phone:570-244-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043621L261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1528078433OtherINDIVIDUAL NPI