Provider Demographics
NPI:1811374606
Name:WEST PENN ALLEGHENY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WEST PENN ALLEGHENY HEALTH SYSTEM, INC.
Other - Org Name:ALLEGHENY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-359-3613
Mailing Address - Street 1:4800 FRIENDSHIP AVE
Mailing Address - Street 2:SUITE 1422
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1722
Mailing Address - Country:US
Mailing Address - Phone:412-605-6389
Mailing Address - Fax:412-605-6344
Practice Address - Street 1:4800 FRIENDSHIP AVE
Practice Address - Street 2:SUITE 1422
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1722
Practice Address - Country:US
Practice Address - Phone:412-605-6389
Practice Address - Fax:412-605-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4825463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007317140457Medicaid