Provider Demographics
NPI:1578644225
Name:PLANNED PARENTHOOD OF WESTERN PENNSYLVANIA, INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF WESTERN PENNSYLVANIA, INC
Other - Org Name:PLANNED PARENTHOOD OF WESTERN PA JOHNSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHEREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-258-9530
Mailing Address - Street 1:933 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-3701
Mailing Address - Country:US
Mailing Address - Phone:412-258-9530
Mailing Address - Fax:412-434-8974
Practice Address - Street 1:817 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2800
Practice Address - Country:US
Practice Address - Phone:814-539-7507
Practice Address - Fax:814-535-5547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD OF WESTERN PENNSYLVANIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0050X
PASP005742B251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Not Answered251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007329360010Medicaid