Provider Demographics
NPI:1013201466
Name:MON-VALE PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:MON-VALE PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-1160
Mailing Address - Street 1:1163 COUNTRY CLUB RD.
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1095
Mailing Address - Country:US
Mailing Address - Phone:724-258-1000
Mailing Address - Fax:724-258-1394
Practice Address - Street 1:3701 ROUTE 88
Practice Address - Street 2:
Practice Address - City:FINLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15332
Practice Address - Country:US
Practice Address - Phone:724-348-4299
Practice Address - Fax:724-348-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty