Provider Demographics
NPI:1073572947
Name:ALLE-KISKI MEDICAL CENTER
Entity Type:Organization
Organization Name:ALLE-KISKI MEDICAL CENTER
Other - Org Name:ALLEGHENY VALLEY HOSPITAL-PSYCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-2472
Mailing Address - Street 1:4 ALLEGHENY CENTER
Mailing Address - Street 2:FLOOR 10
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-330-5040
Mailing Address - Fax:
Practice Address - Street 1:1301 CARLISLE STREET
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1152
Practice Address - Country:US
Practice Address - Phone:724-224-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLE-KISKI MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA940590273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0902OtherHIGHMARK BLUE CROSS #
PA39S032Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA1007447680002Medicaid