Provider Demographics
NPI:1558681619
Name:SRMC HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:SRMC HEALTHCARE GROUP LLC
Other - Org Name:GREENE COUNTY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9849
Mailing Address - Street 1:350 BONAR AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1608
Mailing Address - Country:US
Mailing Address - Phone:724-627-8582
Mailing Address - Fax:
Practice Address - Street 1:236 ELM DR STE 105
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8265
Practice Address - Country:US
Practice Address - Phone:724-627-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112035Medicare PIN