Healthcare Provider Details

I. General information

NPI: 1861424525
Provider Name (Legal Business Name): SRMC HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BONAR AVE
WAYNESBURG PA
15370-1608
US

IV. Provider business mailing address

103 CONTINENTAL PL SUITE 200
BRENTWOOD TN
37027-1041
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-2645
  • Fax: 724-627-2697
Mailing address:
  • Phone: 615-844-9800
  • Fax: 615-844-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN L. PAGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-844-9849