Healthcare Provider Details

I. General information

NPI: 1588015440
Provider Name (Legal Business Name): HEGEMONY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RENAISSANCE DR SUITE 302
BUTLER PA
16001-7612
US

IV. Provider business mailing address

200 RENAISSANCE DR SUITE 302
BUTLER PA
16001-7612
US

V. Phone/Fax

Practice location:
  • Phone: 724-906-4848
  • Fax: 724-909-1716
Mailing address:
  • Phone: 724-906-4848
  • Fax: 724-909-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS V FALONE
Title or Position: DOCTOR
Credential: D.O.
Phone: 724-906-4848