Provider Demographics
NPI:1003887415
Name:PRESBYTERIAN MEDICAL CENTER OF OAKMONT PA INC
Entity Type:Organization
Organization Name:PRESBYTERIAN MEDICAL CENTER OF OAKMONT PA INC
Other - Org Name:THE WILLOWS OF PRESBYTERIAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGENE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:412-826-6081
Mailing Address - Street 1:1215 HULTON RD
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1135
Mailing Address - Country:US
Mailing Address - Phone:412-828-5600
Mailing Address - Fax:412-826-6121
Practice Address - Street 1:1215 HULTON RD
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1135
Practice Address - Country:US
Practice Address - Phone:412-828-5600
Practice Address - Fax:412-826-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA161502313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0686OtherBLUE CROSS
PA15720OtherADVANTRA
PA105OtherUPMC
PA0010338930002Medicaid
PA0686OtherBLUE CROSS
PA0010338930002Medicaid