1063646438 NPI number — PRIMARY CARE GROUP 4 INC

Table of content: (NPI 1063646438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063646438 NPI number — PRIMARY CARE GROUP 4 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE GROUP 4 INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PAUL G. LINDER, M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063646438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1907 LEBANON CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MIFFLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15122-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-655-8515
Provider Business Mailing Address Fax Number:
412-655-3288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 LEBANON CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MIFFLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-655-8515
Provider Business Practice Location Address Fax Number:
412-655-3288
Provider Enumeration Date:
05/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LINDER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEDICAL PHYSICIAN
Authorized Official Telephone Number:
412-655-8515

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)