NPIMap

Sewickley Valley Medical Group, Inc.

Organization Active NPI Non-Pharmacy Dispensing Site · Imperial, PA

NPI 1215079025 · NPPES record last updated Oct 17, 2012

Key facts

NPI
1215079025
Entity type
Organization (NPI type 2)
Primary specialty
Non-Pharmacy Dispensing Site 332900000X
License
MD059981L (PA)
Legal business name
SEWICKLEY VALLEY MEDICAL GROUP, INC.
Practice address
300 Penn Lincoln Dr
Imperial, PA 15126-9772
Phone
(724) 695-2411
NPI assigned
Feb 12, 2007
Organization subpart
Yes
Parent organization (as reported)
MEDVANTX, INC

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Tri - State Medical Group Inc (92 organizations share this tax ID)
Part of
Tri - State Medical Group Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD059981L PA Yes

Addresses

Primary practice location

300 Penn Lincoln Dr
Imperial, PA 15126-9772

Mailing address

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2012.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1215079025",
    "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": "300 PENN LINCOLN DR",
            "city": "IMPERIAL",
            "state": "PA",
            "postal_code": "151269772",
            "telephone_number": "724-695-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEWICKLEY VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC",
        "enumeration_date": "2007-02-12",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD059981L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Imperial, PA

All providers in Imperial, PA · Non-Pharmacy Dispensing Site in Pennsylvania

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