Provider Demographics
NPI:1295000982
Name:PIONEER CITY URGENT CARE LLC
Entity Type:Organization
Organization Name:PIONEER CITY URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-282-4100
Mailing Address - Street 1:PO BOX 1644
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0644
Mailing Address - Country:US
Mailing Address - Phone:570-282-4100
Mailing Address - Fax:570-282-4200
Practice Address - Street 1:267 BROOKLYN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2836
Practice Address - Country:US
Practice Address - Phone:570-282-4100
Practice Address - Fax:570-282-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty