Provider Demographics
NPI:1053319871
Name:THE CIRCULATORY CENTER OF PA, INC.
Entity Type:Organization
Organization Name:THE CIRCULATORY CENTER OF PA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-6750
Mailing Address - Street 1:397 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1375
Mailing Address - Country:US
Mailing Address - Phone:330-759-6750
Mailing Address - Fax:330-759-6755
Practice Address - Street 1:300 CHAPEL HARBOR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4131
Practice Address - Country:US
Practice Address - Phone:412-967-9220
Practice Address - Fax:412-967-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207R00000X, 207V00000X
PAMD039604L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA488669Medicare ID - Type Unspecified