NPIMap

Organization Active NPI

Sewickley Primary Care, LLC

  • Non-Pharmacy Dispensing Site
  • Sewickley, PA
National Provider Identifier
1285777136
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD045483L Issued in PA
Legal business name
SEWICKLEY PRIMARY CARE, LLC
Practice address
701 Broad St
Suite 4B - 4TH Floor
Sewickley, PA 15143-1652
Phone
(412) 741-0985
NPI assigned
Feb 14, 2007
Last updated
Oct 17, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX,INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD045483L PA Primary

Addresses

Primary practice location

701 Broad St
Suite 4B - 4TH Floor
Sewickley, PA 15143-1652

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Baden Area Healthcare10 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 9

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

Locations

701 Broad St
Ste 4B
Sewickley, PA 15143
Phone (412) 741-0985

Practitioners & affiliated clinicians

Practitioners 2

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1285777136",
    "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": "701 BROAD ST",
            "address_2": "SUITE 4B - 4TH FLOOR",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "151431652",
            "telephone_number": "412-741-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEWICKLEY PRIMARY CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX,INC.",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIR. OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD045483L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewickley, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.