Healthcare Provider Details

I. General information

NPI: 1235171570
Provider Name (Legal Business Name): PRIME MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 ROSTRAVER RD
BELLE VERNON PA
15012-9655
US

IV. Provider business mailing address

PO BOX 18619
PITTSBURGH PA
15236-0619
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-2260
  • 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 StatePA

VIII. Authorized Official

Name: DARLA SETHMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 724-929-2640