Provider Demographics
NPI:1023540143
Name:LUNG & WELLNESS CENTERS OF WESTERN PENNSYLVANIA INC
Entity Type:Organization
Organization Name:LUNG & WELLNESS CENTERS OF WESTERN PENNSYLVANIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-256-9606
Mailing Address - Street 1:200 RENAISSANCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7612
Mailing Address - Country:US
Mailing Address - Phone:724-256-9606
Mailing Address - Fax:724-256-9609
Practice Address - Street 1:1701 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2432
Practice Address - Country:US
Practice Address - Phone:878-207-2192
Practice Address - Fax:878-207-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028747070003Medicaid