Provider Demographics
NPI:1033177423
Name:CHESTNUT RIDGE PRIMARY CARE, LTD
Entity Type:Organization
Organization Name:CHESTNUT RIDGE PRIMARY CARE, LTD
Other - Org Name:CHESTNUT RIDGE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-694-0274
Mailing Address - Street 1:555 ROUTE 217
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3484
Mailing Address - Country:US
Mailing Address - Phone:724-694-0274
Mailing Address - Fax:724-694-0383
Practice Address - Street 1:555 ROUTE 217
Practice Address - Street 2:SUITE 5
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3484
Practice Address - Country:US
Practice Address - Phone:724-694-0274
Practice Address - Fax:724-694-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008380780001Medicaid
PA070153Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER