1598700031 NPI number — PASSAVANT PROFESSIONAL ASSOCIATES

Table of content: (NPI 1598700031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598700031 NPI number — PASSAVANT PROFESSIONAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASSAVANT PROFESSIONAL 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:
DIAGNOSTIC CARDIAC LABORATORY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1598700031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9104 BABCOCK BLVD
Provider Second Line Business Mailing Address:
SUITE 4107
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-367-0100
Provider Business Mailing Address Fax Number:
412-357-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9104 BABCOCK BLVD
Provider Second Line Business Practice Location Address:
SUITE 4107
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-367-0100
Provider Business Practice Location Address Fax Number:
412-357-0165
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAHA
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT, CARDIOVASCULAR SERV
Authorized Official Telephone Number:
412-367-6834

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1249 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1488917 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 024400 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080465 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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