Provider Demographics
NPI:1275508103
Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Other - Org Name:WATERDAM MEDICAL ASSOCIATES
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 1:157 WATERDAM RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2573
Mailing Address - Country:US
Mailing Address - Phone:724-941-6697
Mailing Address - Fax:724-941-7563
Practice Address - Street 1:157 WATERDAM RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2573
Practice Address - Country:US
Practice Address - Phone:724-941-6697
Practice Address - Fax:724-941-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PACG1496Medicare PIN
PA0017600750028Medicaid