Healthcare Provider Details

I. General information

NPI: 1669715843
Provider Name (Legal Business Name): MON-VALE PRIMARY CARE PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR STE 290
ROSTRAVER TOWNSHIP PA
15012-4019
US

IV. Provider business mailing address

1163 COUNTRY CLUB ROAD
MONONGAHELA PA
15063
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-6850
  • Fax: 678-553-0330
Mailing address:
  • Phone: 724-258-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SIMMONS
Title or Position: SECRETATY/TREASURER
Credential:
Phone: 724-258-1106