Provider Demographics
NPI:1043281660
Name:MONROEVILLE SPECIALTY CLINIC INC
Entity Type:Organization
Organization Name:MONROEVILLE SPECIALTY CLINIC INC
Other - Org Name:UPMC MONROEVILLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-7713
Mailing Address - Street 1:125 DAUGHERTY DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2749
Mailing Address - Country:US
Mailing Address - Phone:412-374-9385
Mailing Address - Fax:412-374-9490
Practice Address - Street 1:125 DAUGHERTY DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2749
Practice Address - Country:US
Practice Address - Phone:412-374-9385
Practice Address - Fax:412-374-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04291500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20774OtherUPMC HEALTH PLAN
PA0014283020001Medicaid
PABLUE CROSSOther0173
PA73393OtherHEALTH AMERICA/ASSURANCE
PA73393OtherHEALTH AMERICA/ASSURANCE
PA0014283020001Medicaid