Basic Information
Provider Information
NPI: 1497093512
EntityType: 2
ReplacementNPI:  
OrganizationName: PRIMARY HEALTH NETWORK
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CLARION DENTAL CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 63 PITT ST
Address2:  
City: SHARON
State: PA
PostalCode: 161462102
CountryCode: US
TelephoneNumber: 7243423002
FaxNumber: 7243421942
Practice Location
Address1: 30 PINNACLE DR
Address2:  
City: CLARION
State: PA
PostalCode: 162143800
CountryCode: US
TelephoneNumber: 8142239906
FaxNumber: 8142239912
Other Information
ProviderEnumerationDate: 01/24/2013
LastUpdateDate: 07/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SIZER
AuthorizedOfficialFirstName: CARL
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: CHIEF FINANCIAL OFFICER
AuthorizedOfficialTelephone: 7243420126
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: III
AuthorizedOfficialCredential: CPA
NPICertificationDate: 07/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X  N193200000X MULTI-SPECIALTY GROUPDental ProvidersDentistGeneral Practice
261QF0400X  Y Ambulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)

ID Information
IDTypeStateIssuerDescription
100757846010705PA MEDICAID


Home