Healthcare Provider Details

I. General information

NPI: 1831641364
Provider Name (Legal Business Name): HEGEMONY MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8962 HILL DR
NORTH HUNTINGDON PA
15642-3112
US

IV. Provider business mailing address

640 11TH ST
PITCAIRN PA
15140-1111
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-9700
  • Fax: 724-909-1716
Mailing address:
  • Phone: 724-863-9700
  • Fax: 724-909-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD037134L
License Number StatePA

VIII. Authorized Official

Name: MR. MITAR KOZOMARA
Title or Position: OFFICE MANAGER
Credential:
Phone: 724-863-9700