Provider Demographics
NPI:1245295757
Name:TRIVALLEY PRIMARY CARE, PC
Entity type:Organization
Organization Name:TRIVALLEY PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTZANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-257-8601
Mailing Address - Street 1:519 S 5TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1042
Mailing Address - Country:US
Mailing Address - Phone:215-257-8601
Mailing Address - Fax:
Practice Address - Street 1:519 S 5TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1042
Practice Address - Country:US
Practice Address - Phone:215-257-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty