1124217401 NPI number — BENEDUM GERIATRIC CENTER

Table of content: (NPI 1124217401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124217401 NPI number — BENEDUM GERIATRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEDUM GERIATRIC CENTER
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:
Provider Other Organization Name Type Code:
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:
1124217401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LOTHROP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-692-4622
Provider Business Mailing Address Fax Number:
412-692-4225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 N BELLEFIELD AVE
Provider Second Line Business Practice Location Address:
FIFTH FLOOR, ROOM 532
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-2695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-383-1931
Provider Business Practice Location Address Fax Number:
412-383-1308
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
412-692-4200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD030672E , 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: C28987 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011419800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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