Provider Demographics
NPI:1790447258
Name:GREENTREE MEDICAL CENTER URGENT CARE
Entity Type:Organization
Organization Name:GREENTREE MEDICAL CENTER URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KONKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-883-2223
Mailing Address - Street 1:995 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3242
Mailing Address - Country:US
Mailing Address - Phone:412-920-1700
Mailing Address - Fax:412-920-4700
Practice Address - Street 1:995 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3242
Practice Address - Country:US
Practice Address - Phone:412-920-1700
Practice Address - Fax:412-920-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027508530003Medicaid