Provider Demographics
NPI:1073664769
Name:PREFERRED PRIMARY CARE PHYSICIANS
Entity Type:Organization
Organization Name:PREFERRED PRIMARY CARE PHYSICIANS
Other - Org Name:PPCP JACOB MURPHY LANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-531-2902
Mailing Address - Street 1:202 JACOB MURPHY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2686
Mailing Address - Country:US
Mailing Address - Phone:724-437-1109
Mailing Address - Fax:
Practice Address - Street 1:202 JACOB MURPHY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2686
Practice Address - Country:US
Practice Address - Phone:724-437-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011129500004Medicaid
PA1014646700001Medicaid
PA0011227500003Medicaid
PAC95351Medicare UPIN
PA091105JFZMedicare ID - Type Unspecified
PA1014646700001Medicaid
PA090338JFZMedicare ID - Type Unspecified
PAC29525Medicare UPIN
PA0011129500004Medicaid