Provider Demographics
NPI:1558413872
Name:PREFERRED PRIMARY CARE PHYSICIANS
Entity Type:Organization
Organization Name:PREFERRED PRIMARY CARE PHYSICIANS
Other - Org Name:PPCP MCCLELLANDTOWN RD COOK LABUDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:412-531-2902
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:80 MATTHEW DR STE 2001
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8927
Practice Address - Country:US
Practice Address - Phone:724-483-1808
Practice Address - Fax:724-438-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010832780002Medicaid
PA0009431500002Medicaid
PAC28212Medicare UPIN
PA0009431500002Medicaid
PA0010832780002Medicaid
PAB36217Medicare UPIN