Healthcare Provider Details

I. General information

NPI: 1083856165
Provider Name (Legal Business Name): PRIME MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT COUCH RD SUITE 275
PITTSBURGH PA
15241-1041
US

IV. Provider business mailing address

515 BROAD AVE
BELLE VERNON PA
15012-1405
US

V. Phone/Fax

Practice location:
  • Phone: 412-831-2288
  • Fax: 412-831-2679
Mailing address:
  • Phone: 724-929-4930
  • Fax: 724-929-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD037195E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037112E
License Number StatePA

VIII. Authorized Official

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