Provider Demographics
NPI:1932356201
Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Entity Type:Organization
Organization Name:WEST PENN PHYSICIAN PRACTICE NETWORK
Other - Org Name:EMILIO VILLEGAS, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CECILI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-4813
Mailing Address - Street 1:100 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3552
Mailing Address - Country:US
Mailing Address - Phone:724-863-1204
Mailing Address - Fax:724-863-9169
Practice Address - Street 1:100 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3552
Practice Address - Country:US
Practice Address - Phone:724-863-1204
Practice Address - Fax:724-863-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015269880005Medicaid
PA098763U31Medicare PIN