Healthcare Provider Details

I. General information

NPI: 1144390683
Provider Name (Legal Business Name): PRIMARY CARE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BRADDOCK AVE
BRADDOCK PA
15104-1804
US

IV. Provider business mailing address

7227 HAMILTON AVE
PITTSBURGH PA
15208-1814
US

V. Phone/Fax

Practice location:
  • Phone: 412-351-6300
  • Fax: 412-351-6500
Mailing address:
  • Phone: 412-244-4700
  • Fax: 412-244-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WILFORD A. PAYNE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 412-244-4700