Provider Demographics
NPI:1386674356
Name:WEST PENN ALLEGHENY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WEST PENN ALLEGHENY HEALTH SYSTEM, INC.
Other - Org Name:ASSOCIATED SURGEONS OF WESTERN PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CECILI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-4813
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-0282
Mailing Address - Fax:412-578-0259
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 338
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208600000X, 2086S0102X, 2086S0129X, 2086X0206X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750269Medicaid
WV3810008519Medicaid
PA1007277200071Medicaid
ME432728800Medicaid
PADB3773Medicare PIN
PA028672Medicare PIN