Provider Demographics
NPI:1710017025
Name:COLAIZZI PEDORTHIC CENTER
Entity Type:Organization
Organization Name:COLAIZZI PEDORTHIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLAIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:412-761-8108
Mailing Address - Street 1:617 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202
Mailing Address - Country:US
Mailing Address - Phone:412-761-8100
Mailing Address - Fax:
Practice Address - Street 1:617 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3112
Practice Address - Country:US
Practice Address - Phone:412-761-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVOT560OtherUPMC HEALTH PLAN
PA01730343Medicaid
PA208657OtherBLUE CROSS BLUE SHIELD
PA01730343Medicaid