Provider Demographics
NPI:1053695148
Name:INTEGRATED MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:INTEGRATED MEDICAL GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PILLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-5455
Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-5455
Mailing Address - Fax:570-622-5493
Practice Address - Street 1:1626 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2230
Practice Address - Fax:570-622-5724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MEDICAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty