Provider Demographics
NPI:1649208398
Name:NORTH SIDE CHRISTIAN HEALTH CENTER
Entity Type:Organization
Organization Name:NORTH SIDE CHRISTIAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-321-4001
Mailing Address - Street 1:620 E OHIO ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5620
Mailing Address - Country:US
Mailing Address - Phone:412-321-4001
Mailing Address - Fax:
Practice Address - Street 1:620 E OHIO ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5620
Practice Address - Country:US
Practice Address - Phone:412-321-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA550534Medicare ID - Type Unspecified