MEDICARE: FAYETTE MEDICAL ASSOCIATES 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
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	26073	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	63354	OTHER	PA	UNISON
2	B134	OTHER	PA	UPMC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	356571	OTHER	PA	HIGHMARK
6	WC05	OTHER	PA	HEALTH AMERICA
7	1035004	OTHER	PA	GATEWAY

General Provider Information

NPI Number	:	1427022706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYETTE MEDICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	211 EASY ST
Second Line	:
City	:	UNIONTOWN
State	:	PA
Zip	:	15401-3129
Country	:	US
Telephone Number	:	724-434-1650
Fax Number	:	724-434-1659

Provider Business Practice Location Address
First Line	:	111B ROBERTS RD
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-1105
Country	:	US
Telephone Number	:	724-785-2161
Fax Number	:	724-785-3187

Authorized Official
Title or Position	:	MEDICAL BILLER
Name	:	CHARLENE PULICE
Credential	:
Telephone Number	:	724-434-1650

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/12/2008

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