1649409384 NPI number — PRESSLEY RIDGE

Table of content: (NPI 1649409384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649409384 NPI number — PRESSLEY RIDGE

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
PRESSLEY RIDGE
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:
1649409384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 MARSHALL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15214-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-321-6995
Provider Business Mailing Address Fax Number:
412-321-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 OHIO RIVER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-321-6995
Provider Business Practice Location Address Fax Number:
412-321-7008
Provider Enumeration Date:
07/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIRECTOR OF ACCOUNTING
Authorized Official Telephone Number:
412-321-6995

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  438950 , 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: 100003088 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".