Healthcare Provider Details

I. General information

NPI: 1447551783
Provider Name (Legal Business Name): SRMC HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 7TH STREET
WAYNESBURG PA
15370
US

IV. Provider business mailing address

350 BONAR AVE
WAYNESBURG PA
15370-1608
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-2642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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