Provider Demographics
NPI:1366502262
Name:CENTER FOR RENAL CARE AT SHADYSIDE, LTD
Entity Type:Organization
Organization Name:CENTER FOR RENAL CARE AT SHADYSIDE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J. GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUTERUCCI
Authorized Official - Suffix:SR
Authorized Official - Credentials:NHA
Authorized Official - Phone:412-661-7026
Mailing Address - Street 1:440 S. FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-661-7026
Mailing Address - Fax:
Practice Address - Street 1:5511 BAUM BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1203
Practice Address - Country:US
Practice Address - Phone:412-661-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA392737Medicare Oscar/Certification