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NPI Code Detail

MEDICARE: PRIMARY CARE GROUP 5, INC.

MEDICARE: PRIMARY CARE GROUP 5, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1124256805
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE GROUP 5, INC.
Provider Business Mailing Address
First Line : 4 ALLEGHENY CTR FL 7
Second Line :
City : PITTSBURGH
State : PA
Zip : 15212-5255
Country : US
Telephone Number : 412-330-5861
Fax Number : 412-330-5544
Provider Business Practice Location Address
First Line : 67 OLD CLAIRTON RD
Second Line :
City : PITTSBURGH
State : PA
Zip : 15236-3907
Country : US
Telephone Number : 412-655-3444
Fax Number : 412-655-2228
Authorized Official
Title or Position : DIRECTOR PROVIDER ENROLLMENT
Name : DENISE NOEL
Credential :
Telephone Number : 412-330-5861
Provider Enumeration Date : 07/01/2009
Last Update Date : 10/06/2020

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Directions to “PRIMARY CARE GROUP 5, INC. ” Practice Location

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