Provider Demographics
NPI:1942270913
Name:AMORY MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:AMORY MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-270-6525
Mailing Address - Street 1:22 E END CTR
Mailing Address - Street 2:
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6968
Mailing Address - Country:US
Mailing Address - Phone:570-270-6525
Mailing Address - Fax:570-270-6527
Practice Address - Street 1:22 E END CTR
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6968
Practice Address - Country:US
Practice Address - Phone:570-270-6525
Practice Address - Fax:570-270-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA31 54831332BX2000X
PA3154831332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101987680-0001Medicaid
PA4926330001Medicare NSC