Provider Demographics
NPI:1740283845
Name:METRO FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:METRO FAMILY PRACTICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-247-2310
Mailing Address - Street 1:1789 S BRADDOCK AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1842
Mailing Address - Country:US
Mailing Address - Phone:412-247-2310
Mailing Address - Fax:412-247-4060
Practice Address - Street 1:1789 S BRADDOCK AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1842
Practice Address - Country:US
Practice Address - Phone:412-247-2310
Practice Address - Fax:412-247-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100728002261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007280020006Medicaid
PA725502OtherHIGHMARK BLUES
PA1007280020006Medicaid
PA391925Medicare ID - Type UnspecifiedMEDICARE
PW77125Medicare ID - Type UnspecifiedMEDICARE PART B