Healthcare Provider Details

I. General information

NPI: 1861775579
Provider Name (Legal Business Name): SRMC HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ELM DR SUITE 105
WAYNESBURG PA
15370-8265
US

IV. Provider business mailing address

350 BONAR AVE
WAYNESBURG PA
15370-1608
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-1934
  • Fax: 724-627-1994
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA COWIE
Title or Position: CEO
Credential:
Phone: 724-627-3101