Provider Demographics
NPI:1912972563
Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type:Organization
Organization Name:ALLEGHENY MEDICAL PRACTICE NETWORK
Other - Org Name:PRIMARY CARE PROFESSIONALS
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 1:160 GALLERY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-941-7144
Mailing Address - Fax:724-941-7625
Practice Address - Street 1:160 GALLERY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:724-941-7144
Practice Address - Fax:724-941-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017600750028Medicaid
PA074479Medicare ID - Type Unspecified