Provider Demographics
NPI:1841252582
Name:AMY R STINE ESTATE
Entity type:Organization
Organization Name:AMY R STINE ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OF ESTATE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-367-3849
Mailing Address - Street 1:8150 PERRY HWY
Mailing Address - Street 2:SUITE 332
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5232
Mailing Address - Country:US
Mailing Address - Phone:412-630-8250
Mailing Address - Fax:412-630-8251
Practice Address - Street 1:8150 PERRY HWY
Practice Address - Street 2:SUITE 332
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5232
Practice Address - Country:US
Practice Address - Phone:412-630-8250
Practice Address - Fax:412-630-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036523E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA250116OtherUPMC HEALTH PLAN
PA250116OtherUPMC HEALTH PLAN
PAB40947Medicare UPIN