Provider Demographics
NPI:1114992484
Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Other - Org Name:EAST SUBURBAN OBGYN ASSSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5523
Mailing Address - Street 1:2580 HAYMAKER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3518
Mailing Address - Country:US
Mailing Address - Phone:412-856-7500
Mailing Address - Fax:412-856-6079
Practice Address - Street 1:2580 HAYMAKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3518
Practice Address - Country:US
Practice Address - Phone:412-856-7500
Practice Address - Fax:412-856-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PACG1496Medicare PIN
PA0017600750028Medicaid