Provider Demographics
NPI:1942424056
Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Other - Org Name:FORBES FAMILY PRACTICE (PSYCHOLOGY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5523
Mailing Address - Street 1:2566 HAYMAKER RD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3517
Mailing Address - Country:US
Mailing Address - Phone:412-858-2760
Mailing Address - Fax:412-858-2765
Practice Address - Street 1:2566 HAYMAKER RD
Practice Address - Street 2:BUILDING ONE
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3517
Practice Address - Country:US
Practice Address - Phone:412-858-2760
Practice Address - Fax:412-858-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PACG1496Medicare PIN
PA0017600750028Medicaid