Healthcare Provider Details

I. General information

NPI: 1780086694
Provider Name (Legal Business Name): FAYETTE PHYSICIAN NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BERKELEY ST
UNIONTOWN PA
15401-5514
US

IV. Provider business mailing address

211 EASY ST SUITE 127
UNIONTOWN PA
15401-3129
US

V. Phone/Fax

Practice location:
  • Phone: 724-430-6889
  • Fax: 724-430-3384
Mailing address:
  • Phone: 724-430-8032
  • Fax: 724-434-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WORKMAN
Title or Position: REV CYCLE MANAGER
Credential:
Phone: 724-430-5181