Organization
SPECIALTY GROUP PRACTICE 1, INC.
Active
Parent organization
JEFFERSON REGIONAL MEDICAL CENTER
Other names
Phitayakorn Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEFFERSON REGIONAL MEDICAL CENTER
Authorized official
DR. CHET PHITAYAKORN MD (PRESIDENT)
(412) 469-7030
Entity
Organization
Contact information
Practice address
575 COAL VALLEY RD, SUITE 365, CLAIRTON, PA 15025-3730
(412) 469-7030
Mailing address
575 COAL VALLEY RD, SUITE 365, CLAIRTON, PA 15025-3730
(412) 469-7030
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD031414L
PA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
MD038772E
PA
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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