Provider Demographics
NPI:1073534723
Name:PRIME MEDICAL GROUP
Entity Type:Organization
Organization Name:PRIME MEDICAL GROUP
Other - Org Name:PRIME MEDICAL CHAUHAN AND ASSOC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORNBAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-929-4930
Mailing Address - Street 1:1645 ROSTRAVER RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-9655
Mailing Address - Country:US
Mailing Address - Phone:724-929-2640
Mailing Address - Fax:
Practice Address - Street 1:515 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1405
Practice Address - Country:US
Practice Address - Phone:724-929-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA769210OtherHIGHMARK BLUE SHIELD
PA692541OtherHIGHMARK BLUE SHIELD
PA692646OtherHIGHMARK BLUE SHIELD
PA1007726550009Medicaid
PA331905OtherHIGHMARK BLUE SHIELD
PA181174K55Medicare PIN
PAH74915Medicare UPIN
PA074417K55Medicare PIN
PA769210OtherHIGHMARK BLUE SHIELD
PAC32940Medicare UPIN
PA1007726550009Medicaid