1184778177 NPI number — GENESIS MEDICAL ASSOCIATES, INC

Table of content: (NPI 1184778177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184778177 NPI number — GENESIS MEDICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS MEDICAL ASSOCIATES, INC
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:
1184778177
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:
8150 PERRY HWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-369-9550
Provider Business Mailing Address Fax Number:
412-369-9566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 VIP DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-6932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-935-5330
Provider Business Practice Location Address Fax Number:
724-935-5098
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KISSINGER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
412-369-9550

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 878059 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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