Provider Demographics
NPI:1619626827
Name:WEXFORD HEALTH SOURCES
Entity Type:Organization
Organization Name:WEXFORD HEALTH SOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-334-0465
Mailing Address - Street 1:501 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2749
Practice Address - Country:US
Practice Address - Phone:412-937-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty