Provider Demographics
NPI:1518369792
Name:FAYETTE PHYSICIAN NETWORK INC
Entity Type:Organization
Organization Name:FAYETTE PHYSICIAN NETWORK INC
Other - Org Name:FPN CONNELLSVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:REV CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-430-5181
Mailing Address - Street 1:224 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2654
Mailing Address - Country:US
Mailing Address - Phone:724-626-7335
Mailing Address - Fax:724-626-7339
Practice Address - Street 1:224 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2654
Practice Address - Country:US
Practice Address - Phone:724-626-7335
Practice Address - Fax:724-626-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty