1043210420 NPI number — ALLEGHENY CLINIC

Table of content: (NPI 1043210420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043210420 NPI number — ALLEGHENY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGHENY CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AGH PHYSIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043210420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 FEDERAL ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-660-6777
Provider Business Mailing Address Fax Number:
412-359-8340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 FEDERAL ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-660-6777
Provider Business Practice Location Address Fax Number:
412-359-8340
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CECII
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE SPECIALIST
Authorized Official Telephone Number:
412-330-4813

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2303804 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007317140107 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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