INTERMOUNTAIN MEDICAL GROUP INC NPI 1356397673

NPI Information

  • NPI: 1356397673
  • Provider Name: INTERMOUNTAIN MEDICAL GROUP, INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 39D0978526
  • Address: 610 WYOMING AVE
    KINGSTON, PA
    ZIP 18704
  • Phone: (570) 288-5441

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NPI Details

INTERMOUNTAIN MEDICAL GROUP, INC is a family medicine in Kingston, PA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. INTERMOUNTAIN MEDICAL GROUP, INC NPI is 1356397673. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

610 WYOMING AVE
KINGSTON, PA
ZIP 18704-702
Phone: (570) 288-5441
Fax: (570) 288-5842

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Senior Director Provider Enrollment and has the following contact phone number (877) 892-9815.

The CLIA number assigned to this NPI record is 39D0978526 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/26/2006 and was last updated on 1/25/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1133V00000XDietitian, RegisteredNo
2207R00000XInternal MedicineNo
3207V00000XObstetrics & GynecologyNo
4207X00000XOrthopaedic SurgeryNo
52084N0400XPsychiatry & NeurologyNeurologyNo
62085R0202XRadiologyDiagnostic RadiologyNo
7208600000XSurgeryNo
8208800000XUrologyNo
9208D00000XGeneral PracticeNo
10213ES0103XPodiatristFoot & Ankle SurgeryPENNSYLVANIANo
11363AM0700XPhysician AssistantMedicalNo
12363L00000XNurse PractitionerNo
13207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11624037OTHERPENNSYLVANIAHIGHMARK BLUE SHIELD
2100755627MEDICAIDPENNSYLVANIA
3510820OTHERPALAUHIGHMARK BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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