Provider Demographics
NPI:1053470500
Name:WHITE OAK MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WHITE OAK MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:IDREES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-672-6800
Mailing Address - Street 1:1949 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2401
Mailing Address - Country:US
Mailing Address - Phone:412-672-6800
Mailing Address - Fax:
Practice Address - Street 1:1949 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-2401
Practice Address - Country:US
Practice Address - Phone:412-672-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033987L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty