Basic Information
| Provider Information | |||||||||
| NPI: | 1396168589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED INPATIENT MEDICINE ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69233 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212649233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706478990 | ||||||||
| FaxNumber: | 4432926814 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 N RIVER ST | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187640999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705524450 | ||||||||
| FaxNumber: | 5705524455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | DELBRUGGE | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4439490814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 103183032-0001 | 05 | PA | MEDICAID |