Provider Demographics
NPI:1497705784
Name:SOUTH HILLS FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:SOUTH HILLS FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-833-6176
Mailing Address - Street 1:1000 HIGBEE DR
Mailing Address - Street 2:SUITE D202
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-4200
Mailing Address - Country:US
Mailing Address - Phone:412-833-6176
Mailing Address - Fax:412-833-6421
Practice Address - Street 1:1000 HIGBEE DR
Practice Address - Street 2:SUITE D202
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-4200
Practice Address - Country:US
Practice Address - Phone:412-833-6176
Practice Address - Fax:412-833-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001758961Medicaid
PA001758961Medicaid