Provider Demographics
NPI:1265448898
Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Entity Type:Organization
Organization Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Other - Org Name:ALLEGHENY GENERAL HOSPITAL SOMERSET DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM VP OF 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:412-359-8550
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3131
Mailing Address - Fax:412-359-4108
Practice Address - Street 1:229 S KIMBERLY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2022
Practice Address - Country:US
Practice Address - Phone:814-445-6127
Practice Address - Fax:814-445-5627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA530101261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277200102Medicaid
PA1007508630045Medicaid
PA393504Medicare ID - Type UnspecifiedSOMERSET DIALYSIS CENTER