Provider Demographics
NPI:1346571676
Name:INSTITUTE OF PALLIATIVE MEDICINE PC
Entity type:Organization
Organization Name:INSTITUTE OF PALLIATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-586-8990
Mailing Address - Street 1:1 COUNTRY CLUB PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9199
Mailing Address - Country:US
Mailing Address - Phone:570-586-8990
Mailing Address - Fax:
Practice Address - Street 1:1 COUNTRY CLUB PL
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9199
Practice Address - Country:US
Practice Address - Phone:570-586-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-046153-L207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077501VP6OtherPTAN
PA1273749Medicaid
PA1273749Medicaid