Provider Demographics
NPI:1649669375
Name:AGBODZIE, LLC
Entity type:Organization
Organization Name:AGBODZIE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBODZIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:412-794-8631
Mailing Address - Street 1:168 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-1051
Mailing Address - Country:US
Mailing Address - Phone:412-794-8631
Mailing Address - Fax:
Practice Address - Street 1:168 ALLEGHENY RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-1051
Practice Address - Country:US
Practice Address - Phone:412-794-8631
Practice Address - Fax:412-794-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011971261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty