MEDICARE: HEGEMONY MANAGEMENT SERVICES, LLC

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	MD037134L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD037134L	OTHER	PA	PA LICENCE

General Provider Information

NPI Number	:	1831641364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEGEMONY MANAGEMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	640 11TH ST
Second Line	:
City	:	PITCAIRN
State	:	PA
Zip	:	15140-1111
Country	:	US
Telephone Number	:	724-863-9700
Fax Number	:	724-909-1716

Provider Business Practice Location Address
First Line	:	8962 HILL DR
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-3112
Country	:	US
Telephone Number	:	724-863-9700
Fax Number	:	724-909-1716

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. MITAR KOZOMARA
Credential	:
Telephone Number	:	724-863-9700

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	11/30/2016

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