Provider Demographics
NPI:1861667206
Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Entity Type:Organization
Organization Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Other - Org Name:WESTERN PENNSYLVANIA INFECTIOUS DISEASE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CECILI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-4813
Mailing Address - Street 1:1301 CARLISLE ST
Mailing Address - Street 2:ALLE-KISKI MEDICAL CENTER
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1152
Mailing Address - Country:US
Mailing Address - Phone:724-224-5100
Mailing Address - Fax:412-330-5522
Practice Address - Street 1:1301 CARLISLE ST
Practice Address - Street 2:ALLE-KISKI MEDICAL CENTER
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1152
Practice Address - Country:US
Practice Address - Phone:724-224-5100
Practice Address - Fax:412-330-5522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN PHYSICIAN PRACTICE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015269880004Medicaid
PA1015269880004Medicaid