Provider Demographics
NPI:1245245612
Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Entity type:Organization
Organization Name:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:WPAHS CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-359-8550
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3131
Mailing Address - Fax:412-359-4108
Practice Address - Street 1:1620 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2101
Practice Address - Country:US
Practice Address - Phone:724-224-4382
Practice Address - Fax:724-224-7298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN ALLEGHENY HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA530101261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277200103Medicaid
PA1007508630045Medicaid
PA393513Medicare ID - Type UnspecifiedALLEG VAL RENAL DIALYSIS