Provider Demographics
NPI:1003242140
Name:ALLEGHENY CLINIC
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:COLONIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CECILI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-4813
Mailing Address - Street 1:706 EKASTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9724
Mailing Address - Country:US
Mailing Address - Phone:724-353-1508
Mailing Address - Fax:724-353-2040
Practice Address - Street 1:706 EKASTOWN RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9724
Practice Address - Country:US
Practice Address - Phone:724-353-1508
Practice Address - Fax:724-353-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100731714Medicaid
PA030479Medicare PIN