Provider Demographics
NPI:1790719995
Name:PROVITA MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PROVITA MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-294-3121
Mailing Address - Street 1:260 BUFFALO PLZ
Mailing Address - Street 2:PMB # 300
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8302
Mailing Address - Country:US
Mailing Address - Phone:724-294-3121
Mailing Address - Fax:724-294-3121
Practice Address - Street 1:105 BRANDT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6437
Practice Address - Country:US
Practice Address - Phone:724-772-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-003846-L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPR255066OtherGROUP#PA.BLUE SHIELD