Provider Demographics
NPI:1497729891
Name:FAYETTE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FAYETTE MEDICAL ASSOCIATES INC
Other - Org Name:THE DOCTORS OFFICE SMITHFIELD
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 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8943
Practice Address - Country:US
Practice Address - Phone:724-569-5140
Practice Address - Fax:724-569-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037778OtherGATEWAY
PAE035OtherUPMC
PA26071OtherRAILROAD MEDICARE
PA356567OtherHIGHMARK
PA63356OtherUNISON
PA0015441410018Medicaid
PAWC53OtherHEALTH AMERICA
PA63356OtherUNISON