1184672800 NPI number — ADVANCED INTEGRATED MEDICAL LLC

Table of content: (NPI 1184672800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184672800 NPI number — ADVANCED INTEGRATED MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED INTEGRATED MEDICAL LLC
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:
1184672800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800A MCKNIGHT RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-630-9080
Provider Business Mailing Address Fax Number:
412-630-9553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800A MCKNIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-630-9080
Provider Business Practice Location Address Fax Number:
412-630-9553
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRANT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-630-9080

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0018131140002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210469 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 241952 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 224581 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".