Provider Demographics
NPI:1245775774
Name:ALLEGHENY HEALTH NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY HEALTH NETWORK
Other - Org Name:SLIPPERY ROCK PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-794-4009
Mailing Address - Street 1:621 KELLY BLVD
Mailing Address - Street 2:PO BOX 143
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-8523
Mailing Address - Country:US
Mailing Address - Phone:724-774-4009
Mailing Address - Fax:724-794-4099
Practice Address - Street 1:621 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-8523
Practice Address - Country:US
Practice Address - Phone:724-774-4009
Practice Address - Fax:724-794-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty