FAYETTE PHYSICIAN NETWORK INC (NPI# 1154714368) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154714368 |
| Entity Type | Organization |
| Organization Name | FAYETTE PHYSICIAN NETWORK INC |
| Other Organization Name | FAYETTE PHYSICIAN NETWORK- CONNELSVILLE |
| Practice Address |
224 Memorial Blvd Connellsville PA 15425-2654 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 7246267335 |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |
| 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 | OS010452L | PA | Suppliers |
| Other Name | Type Code |
|---|---|
| Fayette Physician Network- Connelsville | 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 |
| 1053704429 | Fayette Physician Network Inc | Non-Pharmacy Dispensing Site | 2175 Mcclellandtown Rd, Masontown, PA 15461-2593 | 2015-03-10 |
| 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 |
224 MEMORIAL BLVD |
| City | CONNELLSVILLE |
| State | PA |
| Zip Code | 15425-2654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518369792 | Fayette Physician Network Inc | Family Medicine | 224 Memorial Blvd, Connellsville, PA 15425-2654 | 2014-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194272666 | Jennifer Knapp | Counselor | 416 South Pittsburgh Street, Connellsville, PA 15425 | 2016-09-01 |
| 1104290550 | Joseph Slezak | Obstetrics & Gynecology | 159 Keefer Rd, Connesville, PA 15425 | 2015-11-23 |
| 1134564297 | Keli Dawn De Carlo | Counselor | 416 S. Pittsburgh Street, Connellsville Counseling and Psychological Services, Connellsville, PA 15425 | 2013-05-02 |
| 1376823047 | Judith Anne Bell | Family Medicine | 2620-c Memorial Blvd, Highlands Medical, Connellsville, PA 15425 | 2011-08-25 |
| 1891928727 | Laura Ann Barricklow | Pharmacist | 200 Memorial Blvd, Connellsville, PA 15425 | 2009-08-26 |
| 1942323373 | Steven John Roth | Pharmacist | Rt 119 and York Avenue, Connellsville, PA 15425 | 2007-04-09 |
| 1124140694 | Chomiak Dental Associates | Dentist | 215 Noth Pittsburgh Street, Suite B, Connellsville, PA 15425 | 2007-04-04 |
| 1245359470 | Mark A Chemski | Pharmacist | Route 119 and York Ave, Connellsville, PA 15425 | 2007-03-28 |
| 1669590857 | Polepalli S Setty Md Inc | Internal Medicine | 2900 Memorial Blvd, Connellsville, PA 15425 | 2007-03-26 |
| 1376661876 | Connellsville Counseling & Psychological Services | Counselor | 416 South Pittsburgh St, Connellsville, PA 15425 | 2007-03-26 |
| Find all providers in zip 15425 | ||||
| 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 | ||||
| City | CONNELLSVILLE |
| Zip Code | 15425 |
Please comment or provide details below to improve the information on FAYETTE PHYSICIAN NETWORK INC.
| 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.