Healthcare Provider Details

I. General information

NPI: 1295750123
Provider Name (Legal Business Name): SLIPPERY ROCK FAMILY MEDICINE CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 KELLY BLVD
SLIPPERY ROCK PA
16057-1155
US

IV. Provider business mailing address

565 KELLY BLVD
SLIPPERY ROCK PA
16057-1155
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-4023
  • Fax: 724-794-3675
Mailing address:
  • Phone: 724-794-4023
  • Fax: 724-794-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD046378L
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL A MCDONALD
Title or Position: OWNER
Credential: M.D.
Phone: 724-794-4023