Healthcare Provider Details

I. General information

NPI: 1073534723
Provider Name (Legal Business Name): PRIME MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BROAD AVE
BELLE VERNON PA
15012-1405
US

IV. Provider business mailing address

1645 ROSTRAVER RD SUITE 505
BELLE VERNON PA
15012-9655
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-6700
  • Fax:
Mailing address:
  • Phone: 724-929-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN A HORNBAKE
Title or Position: MEDICAL BILLER
Credential:
Phone: 724-929-4930