Provider Demographics
NPI:1720053713
Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Other - Org Name:PRIMARY CARE NORTHSIDE
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 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 200/203
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-321-8882
Mailing Address - Fax:412-321-0870
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 200/203
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-321-8882
Practice Address - Fax:412-321-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PA074494Medicare ID - Type Unspecified