Provider Demographics
NPI:1790837300
Name:PREFERRED PRIMARY CARE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:PREFERRED PRIMARY CARE PHYSICIANS, INC.
Other - Org Name:PPCP CIVITARESE AND GARRETSON
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 1:2375 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-4203
Practice Address - Country:US
Practice Address - Phone:412-276-1560
Practice Address - Fax:412-276-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014695010003Medicaid
PA0010307660003Medicaid
PA0014940860002Medicaid
PA0014695010003Medicaid
PAC50626Medicare UPIN
PA184539JFZMedicare ID - Type Unspecified
PA077265JFZMedicare ID - Type Unspecified
PA0014940860002Medicaid
PA544368JFZMedicare ID - Type Unspecified