Basic Information
| Provider Information | |||||||||
| NPI: | 1508000829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JRMC PHYSICIAN SERVICES CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18119 | ||||||||
| Address2: | SUITE MOB # 310 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152360119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124697932 | ||||||||
| FaxNumber: | 4124695493 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 COAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124697932 | ||||||||
| FaxNumber: | 4124695493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | FRANK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP & COO - CORP ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 4124695487 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JEFFERSON REGIONAL MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1925959 | 01 | PA | HIGHMARK BC/BS | OTHER | 603459 | 01 | PA | HEALTH AMERICA | OTHER | 214204 | 01 | PA | UNISON | OTHER | 1562962 | 01 | PA | GATEWAY | OTHER | 491C | 01 | PA | UPMC | OTHER |