Provider Demographics
NPI:1437455771
Name:ST CLAIR MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:ST CLAIR MEDICAL SERVICES INC
Other - Org Name:SHOULDER AND BORDEAU UROLOGICAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING SPECILIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATNESKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-942-2548
Mailing Address - Street 1:1000 BOWER HILL ROAD
Mailing Address - Street 2:ATTN PAMALYN PATNESKY
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1873
Mailing Address - Country:US
Mailing Address - Phone:412-942-2548
Mailing Address - Fax:
Practice Address - Street 1:1145 BOWER HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1346
Practice Address - Country:US
Practice Address - Phone:412-579-6194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CLAIR HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-03
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208800000X
208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty