Provider Demographics
NPI:1366478000
Name:MMC PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:MMC PHYSICIAN SERVICES INC
Other - Org Name:PHYSICIAN SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:MONSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-527-0603
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642
Mailing Address - Country:US
Mailing Address - Phone:724-864-5017
Mailing Address - Fax:724-864-4975
Practice Address - Street 1:70 LINCOLN WAY EAST SUITE
Practice Address - Street 2:PSI CLINIC
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644
Practice Address - Country:US
Practice Address - Phone:724-527-0408
Practice Address - Fax:724-527-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016515800017Medicaid
PA707074Medicare ID - Type Unspecified