Provider Demographics
NPI:1568462984
Name:ALLEGHENY CLINIC
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:AHN SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5853
Mailing Address - Street 1:4 ALLEGHENY CTR FL 7
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5255
Mailing Address - Country:US
Mailing Address - Phone:412-330-5861
Mailing Address - Fax:412-330-5844
Practice Address - Street 1:320 E NORTH AVE FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3115
Practice Address - Fax:412-359-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007317140093Medicaid
PA030719Medicare PIN
PA1007317140093Medicaid
WV3810010032Medicaid
OHAL9306432Medicare PIN
PA030719Medicare PIN
PACG2280Medicare PIN