Basic Information
| Provider Information | |||||||||
| NPI: | 1295000982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIONEER CITY URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1644 | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187040644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702824100 | ||||||||
| FaxNumber: | 5702824200 | ||||||||
| Practice Location | |||||||||
| Address1: | 267 BROOKLYN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184072836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702824100 | ||||||||
| FaxNumber: | 5702824200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2012 | ||||||||
| LastUpdateDate: | 06/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | MATLAGA | ||||||||
| AuthorizedOfficialFirstName: | ROMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5702824100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.