FAYETTE PHYSICIAN NETWORK INC (NPI# 1053704429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053704429 |
| Entity Type | Organization |
| Organization Name | FAYETTE PHYSICIAN NETWORK INC |
| Other Organization Name | FAYETTE PHYSICIAN NETWORK-MASONTOWN |
| Practice Address |
2175 Mcclellandtown Rd Masontown PA 15461-2593 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 7245832819 |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | MD417327 | PA | Suppliers |
| Other Name | Type Code |
|---|---|
| Fayette Physician Network-Masontown | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518369792 | Fayette Physician Network Inc | Family Medicine | 224 Memorial Blvd, Connellsville, PA 15425-2654 | 2014-09-19 |
| 1447624499 | Fayette Physician Network Inc | Internal Medicine | 20 Highland Park Dr, Uniontown, PA 15401-8922 | 2015-11-13 |
| 1245623453 | Fayette Physician Network Inc | Non-Pharmacy Dispensing Site | 111b Roberts Rd, Grindstone, PA 15442-1105 | 2015-03-12 |
| 1154714368 | Fayette Physician Network Inc | Non-Pharmacy Dispensing Site | 224 Memorial Blvd, Connellsville, PA 15425-2654 | 2015-03-12 |
| 1992107817 | Fayette Physician Network Inc | Internal Medicine | 500 W Berkeley St, Uniontown, PA 15401-5514 | 2014-09-23 |
| 1780086694 | Fayette Physician Network Inc | Psychiatry & Neurology | 500 W Berkeley St, Uniontown, PA 15401-5514 | 2014-09-23 |
| 1710389994 | Fayette Physician Network Inc | Family Medicine | 111b Roberts Rd, Grindstone, PA 15442-1105 | 2014-09-19 |
| 1780086967 | Fayette Physician Network Inc | Family Medicine | 2175 Mcclellandtown Rd, Suite 201, Masontown, PA 15461-2593 | 2014-09-19 |
| 1013319292 | Fayette Physician Network Inc | Family Medicine | 201 Mary Higginson Ln, Suite 1, Uniontown, PA 15401-2658 | 2014-09-19 |
| 1588066765 | Fayette Physician Network Inc | Family Medicine | 25 Main St, Smithfield, PA 15478-8943 | 2014-09-19 |
| Street Address |
2175 MCCLELLANDTOWN RD |
| City | MASONTOWN |
| State | PA |
| Zip Code | 15461-2593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124028527 | Brian Mudry | Family Medicine | 2175 Mcclellandtown Rd, Suite 201, Masontown, PA 15461-2593 | 2005-07-28 |
| 1780086967 | Fayette Physician Network Inc | Family Medicine | 2175 Mcclellandtown Rd, Suite 201, Masontown, PA 15461-2593 | 2014-09-19 |
| 1669793907 | Jaclyn Delgreco | Family Medicine | 2175 Mcclellandtown Rd, Masontown, PA 15461-2593 | 2010-06-22 |
| 1659345924 | Fayette Medical Associates Inc | Family Medicine | 2175 Mcclellandtown Rd, Suite 201, Masontown, PA 15461-2593 | 2006-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184710238 | James Vance Weimer | Dentist | 115 N Water St, Masontown, PA 15461 | 2006-10-05 |
| 1043228539 | Arnold Oehrn Koon | Dentist | 546 North Main Street, Masontown, PA 15461 | 2006-08-03 |
| 1336664960 | Albert Gallatin Human Services | Meals | 22 South Main St, Masontown, PA 15461 | 2017-08-04 |
| 1194996355 | Covilles Personal Care Home | Custodial Care Facility | 5 S 2nd St, Masontown, PA 15461-1538 | 2008-03-17 |
| 1487814430 | Cloverdale Personal Care Home | Custodial Care Facility | 206 Westwood Ave, Masontown, PA 15461-1646 | 2008-06-12 |
| 1225012073 | David P Alan | Optometrist | 203 N Redwood St, Masontown, PA 15461-1668 | 2005-12-05 |
| 1952732992 | Southwestern Eye Centers, LLC | Eyewear Supplier (Equipment, not the service) | 203 N Redwood St, Masontown, PA 15461-1668 | 2013-12-02 |
| 1780848291 | Pouvoir Company LLC | Durable Medical Equipment & Medical Supplies | 203 N Redwood St, Masontown, PA 15461-1668 | 2008-07-14 |
| 1144429002 | Carla Franks | Nurse Practitioner | Amedysis Hospice, 2183 Mcclellandtown Road, Masontown, PA 15461-1727 | 2007-07-12 |
| 1770580623 | James T Rhoades | Optometrist | 500 N Water St, Masontown, PA 15461-1778 | 2005-07-07 |
| Find all providers in zip 15461 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1023655602 | Dedicated Pennsylvania Holding, LLC | Non-Pharmacy Dispensing Site | 330 W Oregon Ave # 170, Philadelphia, PA 19148-4723 | 2019-12-03 |
| 1275193336 | Q Pharma Inc | Non-Pharmacy Dispensing Site | 103 Nesbitt Rd, New Castle, PA 16105-3401 | 2019-06-19 |
| 1770141491 | R&r Eyewear Imports, Inc. | Non-Pharmacy Dispensing Site | 311 W Moreland Rd, Willow Grove, PA 19090-3107 | 2019-05-29 |
| 1174089858 | Centers for Advanced Urology, LLC | Non-Pharmacy Dispensing Site | 400 Davis Dr Ste 200a, Plymouth Meeting, PA 19462-1718 | 2019-02-18 |
| 1811469760 | Dermatology and Mohs Surgery Center PC | Non-Pharmacy Dispensing Site | 920 Lawn Ave Ste 6, Sellersville, PA 18960-1560 | 2018-12-17 |
| 1437624244 | Highpoint Pain & Rehabilitation Physicians | Non-Pharmacy Dispensing Site | 2 Village Road, Horsham, PA 19044 | 2018-10-08 |
| 1649768110 | Qpharma Inc | Non-Pharmacy Dispensing Site | 20 Highland Park Dr Ste 202, Uniontown, PA 15401-8968 | 2018-04-30 |
| 1215424536 | Q Pharma Inc | Non-Pharmacy Dispensing Site | 1321 Fifth Ave Ste 1, Mckeesport, PA 15132-2403 | 2018-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.