Provider Demographics
NPI:1700055514
Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Entity Type:Organization
Organization Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Other - Org Name:WESTERN PENNSYLVANIA OB/GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5207
Mailing Address - Street 1:147 TOWNE SQUARE WAY
Mailing Address - Street 2:BRENTWOOD TOWNE SQUARE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3254
Mailing Address - Country:US
Mailing Address - Phone:412-942-1085
Mailing Address - Fax:412-865-3035
Practice Address - Street 1:147 TOWNE SQUARE WAY
Practice Address - Street 2:BRENTWOOD TOWNE SQUARE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3254
Practice Address - Country:US
Practice Address - Phone:412-942-1085
Practice Address - Fax:412-865-3035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN PHYSICIAN PRACTICE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015269880003Medicaid
PA098763Medicare PIN