1194925107 NPI number — PITTSBURGH NORTH CARDIOLOGY ASSOC

Table of content: (NPI 1194925107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194925107 NPI number — PITTSBURGH NORTH CARDIOLOGY ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PITTSBURGH NORTH CARDIOLOGY ASSOC
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:
1194925107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15202-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-761-4700
Provider Business Mailing Address Fax Number:
412-766-8152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-761-4700
Provider Business Practice Location Address Fax Number:
412-766-8152
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARCOCELLI
Authorized Official First Name:
RUBY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
412-788-4995

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00079075900008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000060053 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC1531 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015654000 . This is a "INDEPENCE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1014077 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 433869 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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