Healthcare Provider Details

I. General information

NPI: 1346276128
Provider Name (Legal Business Name): MMC PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 LINCOLN HWY E
JEANNETTE PA
15644-3141
US

IV. Provider business mailing address

70 LINCOLN HWY E
JEANNETTE PA
15644-3141
US

V. Phone/Fax

Practice location:
  • Phone: 724-523-5250
  • Fax: 724-523-5259
Mailing address:
  • Phone: 724-523-5250
  • Fax: 724-523-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number720605
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MICHAEL ANTON MONSOUR
Title or Position: CEO
Credential:
Phone: 724-523-5250