Provider Demographics
NPI:1487677498
Name:MONVALE ORTHOPEDICS, INC.
Entity Type:Organization
Organization Name:MONVALE ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-379-5802
Mailing Address - Street 1:800 PLAZA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4019
Mailing Address - Country:US
Mailing Address - Phone:724-379-5802
Mailing Address - Fax:
Practice Address - Street 1:800 PLAZA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-4019
Practice Address - Country:US
Practice Address - Phone:724-379-5816
Practice Address - Fax:724-379-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011318300010Medicaid
PA150719OtherHIGHMARK BC BS
PA0011318300010Medicaid
PA=========OtherUPMC HEALTH PLAN