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NPI Code Detail

MEDICARE: PAI PARTICIPANT 25 PC

MEDICARE: PAI PARTICIPANT 25 PC
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1568028314
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAI PARTICIPANT 25 PC
Provider Business Mailing Address
First Line : PO BOX 639676
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-9676
Country : US
Telephone Number : 859-291-4800
Fax Number :
Provider Business Practice Location Address
First Line : 290 RED SCHOOL LN
Second Line :
City : PHILLIPSBURG
State : NJ
Zip : 08865-2276
Country : US
Telephone Number : 908-859-2800
Fax Number : 908-859-4532
Authorized Official
Title or Position : SENIOR MANAGER IN CREDENTIALING/DIR
Name : JILL FORD
Credential :
Telephone Number : 484-643-2629
Provider Enumeration Date : 05/17/2019
Last Update Date : 06/22/2026

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