Basic Information
| Provider Information | |||||||||
| NPI: | 1922443860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12280 ROUTE 30 | ||||||||
| Address2: | |||||||||
| City: | IRWIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156421820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248647447 | ||||||||
| FaxNumber: | 4122793416 | ||||||||
| Practice Location | |||||||||
| Address1: | 12280 ROUTE 30 | ||||||||
| Address2: | |||||||||
| City: | IRWIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156421820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248647447 | ||||||||
| FaxNumber: | 4122793416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2013 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCALISE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7248647447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD044592E | PW | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.