Provider Demographics
NPI:1477854826
Name:JACK MANNHEIMER M.D. PC
Entity Type:Organization
Organization Name:JACK MANNHEIMER M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-469-8220
Mailing Address - Street 1:500 LEWIS RUN RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3056
Mailing Address - Country:US
Mailing Address - Phone:412-469-8220
Mailing Address - Fax:412-469-9365
Practice Address - Street 1:500 LEWIS RUN RD
Practice Address - Street 2:SUITE 129
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-469-8220
Practice Address - Fax:412-469-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
803622OtherHIGHMARK
PAC27343Medicare UPIN