Provider Demographics
NPI:1427022706
Name:FAYETTE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FAYETTE MEDICAL ASSOCIATES INC
Other - Org Name:THE DOCTORS OFFICE BROWNSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-434-1650
Mailing Address - Street 1:211 EASY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-434-1650
Mailing Address - Fax:724-434-1659
Practice Address - Street 1:111B ROBERTS RD
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1105
Practice Address - Country:US
Practice Address - Phone:724-785-2161
Practice Address - Fax:724-785-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA63354OtherUNISON
PAB134OtherUPMC
PA0015441410015Medicaid
PA26073OtherRAILROAD MEDICARE
PA356571OtherHIGHMARK
PAWC05OtherHEALTH AMERICA
PA1035004OtherGATEWAY
PAWC05OtherHEALTH AMERICA