Provider Demographics
NPI:1013220094
Name:PEDIATRIC ALLIANCE, ST. CLAIR DIVISION
Entity Type:Organization
Organization Name:PEDIATRIC ALLIANCE, ST. CLAIR DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:412-278-5100
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-278-5100
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-221-2121
Practice Address - Fax:412-221-2007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ALLIANCE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty