Organization · Type 2 NPI

Fayette Physician Network Inc

Non-Pharmacy Dispensing Site · Connellsville, PA

NPI number 1154714368 Active

Practice location

224 Memorial Blvd
Connellsville, PA 15425-2654

Call (724) 626-7335 Map

Mailing address

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

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	OS010452L (PA)

Non-Pharmacy Dispensing Site: A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

Another provider at this address

Fayette Physician Network IncFamily Medicine Physician Connellsville, PA NPI 1518369792

NPI record

NPI: 1154714368
Entity type: Organization (Type 2)
Issued: Mar 12, 2015
Last updated: Mar 12, 2015
Status: Active
Subpart: Yes of Medvantx, Inc.

Other names

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Fayette Physician Network- Connelsville · doing business as

Authorized official

Kenny Heine
VP of Operations
(858) 964-1506

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1154714368

Fayette Physician Network Inc's National Provider Identifier is 1154714368, issued on Mar 12, 2015. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Connellsville, PA. The record was last updated on Mar 12, 2015.