Provider Demographics
NPI:1376076760
Name:ALLEGHENY CLINIC
Entity type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CREDENTIALING 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:724-272-9068
Mailing Address - Street 1:1673 ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-5217
Mailing Address - Country:US
Mailing Address - Phone:724-758-7559
Mailing Address - Fax:724-758-7560
Practice Address - Street 1:1673 ROUTE 65
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-5217
Practice Address - Country:US
Practice Address - Phone:724-758-7559
Practice Address - Fax:724-758-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty