Provider Demographics
NPI: | 1487206835 |
---|---|
Name: | ALLEGHENY CLINIC |
Entity Type: | Organization |
Organization Name: | ALLEGHENY CLINIC |
Other - Org Name: | AHN PRIMARY CARE BLOOMFIELD |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PROVIDER ENROLLMENT 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: | 412-330-5864 |
Mailing Address - Street 1: | 4727 FRIENDSHIP AVE FL 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURGH |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15224-1779 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-325-0060 |
Mailing Address - Fax: | 412-325-0060 |
Practice Address - Street 1: | 4747 LIBERTY AVE |
Practice Address - Street 2: | |
Practice Address - City: | PITTSBURGH |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15224-2032 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-325-0060 |
Practice Address - Fax: | 412-325-0061 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-07-15 |
Last Update Date: | 2020-10-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |