1912058678 NPI number — PREFERRED PRIMARY CARE PHYSICIANS

Table of content: (NPI 1912058678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912058678 NPI number — PREFERRED PRIMARY CARE PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED PRIMARY CARE PHYSICIANS
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:
PPCP FLEET
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:
1912058678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 TECHNOLOGY DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-9531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-531-2902
Provider Business Mailing Address Fax Number:
412-531-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FLEET ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15220-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-920-0040
Provider Business Practice Location Address Fax Number:
412-920-8129
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ERHARD
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
412-531-2902

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0017367770003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007635550001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010852720007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015589150005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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