1265804678 NPI number — HYGEIA OF PITTSBURGH, LLC

Table of content: (NPI 1265804678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265804678 NPI number — HYGEIA OF PITTSBURGH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYGEIA OF PITTSBURGH, 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:
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:
1265804678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4146 LIBRARY RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15234-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-343-1515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 16TH ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-214-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL MANAGER/OWNER
Authorized Official Telephone Number:
412-343-1515

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  14303601 , 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: 102903961 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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