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General NPI Number Information
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NPI Number | 1407098643
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Entity Type | Organization
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Legal Business Name | PRIME MEDICAL GROUP PCG1
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 1645 ROSTRAVER RD SUITE 202
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City | BELLE VERNON
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State | PA
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Zip | 15012-9655
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Country | US
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Telephone | 724-929-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 515 BROAD AVE
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City | BELLE VERNON
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State | PA
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Zip | 15012-1405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DARLA SETHMAN
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Credential |
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Telephone | 724-929-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD036822L
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License Number State | PA
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