Provider Demographics
NPI:1619489283
Name:PRIVATE PHYSICIANS MEDICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:PRIVATE PHYSICIANS MEDICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-369-5900
Mailing Address - Street 1:10675 PERRY HWY UNIT 243
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-1129
Mailing Address - Country:US
Mailing Address - Phone:412-369-5900
Mailing Address - Fax:412-369-5905
Practice Address - Street 1:5700 CORPORATE DR STE 265
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5861
Practice Address - Country:US
Practice Address - Phone:412-369-5900
Practice Address - Fax:412-369-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006326L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty