Provider Demographics
NPI:1528292281
Name:PRIMARY CARE GROUP 3 INC
Entity type:Organization
Organization Name:PRIMARY CARE GROUP 3 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5861
Mailing Address - Street 1:5426 MIFFLIN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-2350
Mailing Address - Country:US
Mailing Address - Phone:724-462-1800
Mailing Address - Fax:412-462-5501
Practice Address - Street 1:5426 MIFFLIN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-2350
Practice Address - Country:US
Practice Address - Phone:724-462-1800
Practice Address - Fax:412-462-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039877L207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB42198Medicare UPIN