Provider Demographics
NPI:1043662281
Name:IRMC BHS MULTISPECIALTY PHYSICIAN GROUP
Entity type:Organization
Organization Name:IRMC BHS MULTISPECIALTY PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER FINANCE AND ACCOUNTING
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUTTNER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:724-357-7227
Mailing Address - Street 1:640 KOLTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7333
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:1265 WAYNE AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3578
Practice Address - Country:US
Practice Address - Phone:724-717-6417
Practice Address - Fax:724-717-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicare PIN