Provider Demographics
NPI:1609946466
Name:SOUTH HILLS NEPHROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTH HILLS NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAJNI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-466-2220
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:STE 264
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3716
Mailing Address - Country:US
Mailing Address - Phone:412-466-2220
Mailing Address - Fax:412-466-4048
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 264
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3716
Practice Address - Country:US
Practice Address - Phone:412-466-2220
Practice Address - Fax:412-466-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038478L207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1691666OtherHIGHMARK BC/BS
PA0010585890002Medicaid
PA089827Medicare PIN
PA1691666OtherHIGHMARK BC/BS