1003214214 NPI number — CCN AMERICA LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003214214 NPI number — CCN AMERICA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CCN AMERICA LP
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:
6
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:
1003214214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PENN CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15235-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-349-6300
Provider Business Mailing Address Fax Number:
412-349-6724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 S 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-657-6786
Provider Business Practice Location Address Fax Number:
267-324-3594
Provider Enumeration Date:
12/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
POLLACK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
412-349-6300

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP482532 , 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: 1018103020002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2149363 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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