Provider Demographics
NPI:1407359060
Name:PRIMARY HEALTH NETWORK
Entity Type:Organization
Organization Name:PRIMARY HEALTH NETWORK
Other - Org Name:SHENANDOAH HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIZER
Authorized Official - Suffix:III
Authorized Official - Credentials:CPA
Authorized Official - Phone:724-342-0126
Mailing Address - Street 1:63 PITT ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2102
Mailing Address - Country:US
Mailing Address - Phone:724-342-3002
Mailing Address - Fax:724-342-1942
Practice Address - Street 1:624 W CENTRE ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1403
Practice Address - Country:US
Practice Address - Phone:570-671-0300
Practice Address - Fax:570-671-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007578460129Medicaid