Provider Demographics
NPI:1780776294
Name:HEALTH ASSOCIATES OF WESTERN PENNSYLVANIA P C
Entity type:Organization
Organization Name:HEALTH ASSOCIATES OF WESTERN PENNSYLVANIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOHNJULIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-415-1138
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1236
Mailing Address - Country:US
Mailing Address - Phone:412-937-9640
Mailing Address - Fax:412-937-8639
Practice Address - Street 1:100 S JACKSON AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3428
Practice Address - Country:US
Practice Address - Phone:412-415-1138
Practice Address - Fax:412-301-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002042L363AM0700X
PATP005003B363L00000X
207R00000X, 207Q00000X
PAMA052916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101792133Medicaid
PA1517162OtherGATEWAY
PA1905604OtherBCBS
PADF5831OtherRR MCR
PA101792133Medicaid
PA107583Medicare PIN