1619986528 NPI number — ALLEGHENY PAIN MANAGEMENT PC

Table of content: (NPI 1619986528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619986528 NPI number — ALLEGHENY PAIN MANAGEMENT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGHENY PAIN MANAGEMENT PC
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:
1619986528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8000
Provider Second Line Business Mailing Address:
DEPT 866
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14267-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-940-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRASS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
814-940-2000

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  MD053729L , 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: 1556837 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 203262 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ9284 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 120805400 . This is a "OWCP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DR973946 . This is a "PERSONAL BS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 343086 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018776120008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AL1341803 . This is a "HIGHMARK BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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