NPIMap

Organization Active NPI

Fayette Physician Network Inc

Doing business as Fayette Physician Network-Masontown

  • Non-Pharmacy Dispensing Site
  • Masontown, PA
National Provider Identifier
1053704429
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD417327 Issued in PA
Legal business name
FAYETTE PHYSICIAN NETWORK INC
Doing business as
Fayette Physician Network-Masontown
Practice address
2175 McClellandtown Rd
Masontown, PA 15461-2593
Phone
(724) 583-2819
NPI assigned
Mar 10, 2015
Last updated
Mar 10, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD417327 PA Primary

Addresses

Primary practice location

2175 McClellandtown Rd
Masontown, PA 15461-2593

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Fayette Physician Network-Masontown Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fayette Phys Network Inc13 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2175 McClellandtown Rd
Masontown, PA 15461
Phone (724) 583-2819

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1053704429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 MCCLELLANDTOWN RD",
            "city": "MASONTOWN",
            "state": "PA",
            "postal_code": "154612593",
            "telephone_number": "724-583-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE PHYSICIAN NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2015-03-10",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD417327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayette Physician Network-Masontown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Masontown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.