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Organization
PRIME MEDICAL GROUP PCG1
Active
Organization
PRIME MEDICAL GROUP PCG1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLA SETHMAN (PRACTICE ADMINISTRATOR)
(724) 929-2640
Entity
Organization
Contact information
Practice address
1645 ROSTRAVER RD, SUITE 202, BELLE VERNON, PA 15012-9655
(724) 929-2260
Mailing address
515 BROAD AVE, BELLE VERNON, PA 15012-1405
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD036822L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006836970001
—
PA
01
—
PENDING
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/02/2009
Last updated
08/23/2010
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