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General NPI Number Information
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NPI Number | 1588417117
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Entity Type | Organization
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Legal Business Name | PLAID EAGLE MEDICAL PLLC
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 3835 NORTHERN PIKE STE 1
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City | MONROEVILLE
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State | PA
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Zip | 15146-2132
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-1200
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Country | US
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Telephone | 800-640-3451
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINSTRATOR
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Name | MARIANA HANKINS
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Credential |
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Telephone | 801-888-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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