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General NPI Number Information
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NPI Number | 1386877801
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Entity Type | Organization
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Legal Business Name | SPECIALTY GROUP PRACTICE 1, INC.
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 575 COAL VALLEY RD SUITE 365
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City | CLAIRTON
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State | PA
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Zip | 15025-3730
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Country | US
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Telephone | 412-469-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 575 COAL VALLEY RD SUITE 365
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City | CLAIRTON
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State | PA
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Zip | 15025-3730
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Country | US
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Telephone | 412-469-7030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHET PHITAYAKORN
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Credential | MD
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Telephone | 412-469-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD038772E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD031414L
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License Number State | PA
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