1164475091 NPI number — JEFFERSON HILLS SURGICAL ASSOCIATES

Table of content: (NPI 1164475091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164475091 NPI number — JEFFERSON HILLS SURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON HILLS SURGICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164475091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 BROOKS LN
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
JEFFERSON HILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15025-3747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-469-7110
Provider Business Mailing Address Fax Number:
412-469-8938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BROOKS LN
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
JEFFERSON HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15025-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-469-7110
Provider Business Practice Location Address Fax Number:
412-469-8938
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
412-469-7110

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017401990002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102792 . This is a "UPMC FOR LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 876903 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89940 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020041924 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2110489 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7728259 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2119 . This is a "UPMC FOR YOU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1538038 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CI6850 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 076046 . This is a "HIGHMARK PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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