Provider Demographics
NPI:1003929670
Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC
Other - Org Name:PITTSBURGH CARDIO THORACIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER SPECIALTY PRACTICE ADMINIST
Authorized Official - Prefix:
Authorized Official - First Name:LISAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSTEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-224-6474
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-688-0207
Mailing Address - Fax:
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-688-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN ALLEGHENY HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277200022Medicaid
PA031105Medicare PIN