MEDICARE: PRIMARY CARE HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1417027806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	7227 HAMILTON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15208-1814
Country	:	US
Telephone Number	:	412-244-4700
Fax Number	:	412-244-4992

Provider Business Practice Location Address
First Line	:	1800 WEST ST
Second Line	:
City	:	HOMESTEAD
State	:	PA
Zip	:	15120-2578
Country	:	US
Telephone Number	:	412-461-3863
Fax Number	:	412-461-4184

Authorized Official
Title or Position	:	EXCUTIVE DIRECTOR
Name	:	MR. WILFORD A. PAYNE
Credential	:
Telephone Number	:	412-244-4700

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	09/29/2011

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