Perryo Medical Center, PC

Key facts

NPI

1255654075

Entity type

Organization (NPI type 2)

Primary specialty

Non-Pharmacy Dispensing Site 332900000X

License

MD049150L (PA)

Legal business name

PERRYO MEDICAL CENTER, PC

Practice address

405 Liberty Street
Perryopolis, PA 15473

Phone

(724) 736-0443

NPI assigned

Mar 8, 2010

Organization subpart

Yes

Parent organization (as reported)

MEDVANTX, INC.

Authorized official

Name

Kenny Heine

Title

Sr. Director of Operations

Phone

(858) 625-2990

Corporate family (same tax ID) 1

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

• Perryo Medical Center, P C Internal Medicine Physician · Perryopolis, PA · NPI 1982666863
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sanatkumar C Shroff, M.D. Internal Medicine Physician · Perryopolis, PA · NPI 1144213745
  NPD

National Provider Directory

Tax ID family

Perryo Medical Center (2 organizations share this tax ID)

Part of

Tri - State Medical Group Inc

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 23, 2012.

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1255654075",
    "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": "405 LIBERTY STREET",
            "city": "PERRYOPOLIS",
            "state": "PA",
            "postal_code": "15473",
            "telephone_number": "724-736-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRYO MEDICAL CENTER, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2010-03-08",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR. DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD049150L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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