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Fayette Physician Network Inc — NPI 1053704429, Masontown, PA | NPI Central

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NPI 1053704429

OrganizationActive

Fayette Physician Network Inc

NPI 1053704429 · Non-Pharmacy Dispensing Site · Masontown, PA

Provider details

NPI number: 1053704429
Entity type: Organization
Primary specialty: Non-Pharmacy Dispensing SiteSuppliers
Parent organization: Medvantx, Inc.
Organization subpart: Yes
Authorized official: Kenny Heine, Vp of Operations(858) 964-1506
License: MD417327 (PA)

Specialties & taxonomies

Non-Pharmacy Dispensing SitePrimary332900000XLicense MD417327 (PA)
Suppliers

Practice location

2175 Mcclellandtown Rd

Masontown, PA 15461-2593

Phone: (724) 583-2819

Approximate (ZIP-level) locationGet directions

More PA providers

Mailing address

5626 Oberlin Dr

San Diego, CA 92121-1705

Other names (DBA / former)

Doing business as: Fayette Physician Network-Masontown

Registry dates

Enumerated: 2015-03-10
Last updated: 2015-03-10

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.