Healthcare Provider Details
I. General information
NPI: 1912372525
Provider Name (Legal Business Name): PREFERRED PRIMARY CARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/08/2015
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
151 N FRANKLIN ST
WASHINGTON PA
15301-4378
US
IV. Provider business mailing address
701 TECHNOLOGY DR STE 150
CANONSBURG PA
15317-9531
US
V. Phone/Fax
- Phone: 724-222-7240
- Fax: 724-229-7227
- Phone: 412-531-2902
- Fax: 412-531-2948
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
GREGORY
R.
ERHARD
JR.
Title or Position: CEO
Credential:
Phone: 412-531-2902