Provider Demographics
NPI:1568437564
Name:ALLEGHENY MEDICAL PRACTICE NETWROK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWROK
Other - Org Name:BURRELL INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE 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:412-330-5523
Mailing Address - Street 1:2869 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2540
Mailing Address - Country:US
Mailing Address - Phone:724-337-6000
Mailing Address - Fax:724-337-6100
Practice Address - Street 1:2869 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-2540
Practice Address - Country:US
Practice Address - Phone:724-337-6000
Practice Address - Fax:724-337-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PA074494Medicare ID - Type Unspecified
PACG1496Medicare PIN