Healthcare Provider Details

I. General information

NPI: 1285055004
Provider Name (Legal Business Name): SRMC HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
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

350 BONAR AVE
WAYNESBURG PA
15370-1608
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-2463
  • Fax:
Mailing address:
  • Phone: 724-627-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

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