NPIMap

Organization Active NPI

Fayette Physician Network Inc

Doing business as Fayette Physician Network- Connelsville

  • Non-Pharmacy Dispensing Site
  • Connellsville, PA
National Provider Identifier
1154714368
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
OS010452L Issued in PA
Legal business name
FAYETTE PHYSICIAN NETWORK INC
Doing business as
Fayette Physician Network- Connelsville
Practice address
224 Memorial Blvd
Connellsville, PA 15425-2654
Phone
(724) 626-7335
NPI assigned
Mar 12, 2015
Last updated
Mar 12, 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 12, 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 OS010452L PA Primary

Addresses

Primary practice location

224 Memorial Blvd
Connellsville, PA 15425-2654

Mailing address

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

Other names 1

  • Fayette Physician Network- Connelsville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fayette Physicians Network Inc13 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1154714368",
    "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": "224 MEMORIAL BLVD",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154252654",
            "telephone_number": "724-626-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE PHYSICIAN NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-03-12",
        "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": "OS010452L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayette Physician Network- Connelsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Connellsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.