1700123833 NPI number — DE LA TORRE ORTHOTICS & PROSTHETICS

Table of content: (NPI 1700123833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700123833 NPI number — DE LA TORRE ORTHOTICS & PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DE LA TORRE ORTHOTICS & PROSTHETICS
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:
1700123833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 ALPHA DR
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:
15238-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-599-1138
Provider Business Mailing Address Fax Number:
412-599-1155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NORTHPOINTE CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEVEN FIELDS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16046-7867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-779-7700
Provider Business Practice Location Address Fax Number:
724-779-7705
Provider Enumeration Date:
01/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LEIMKUEHLER MOSS
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-325-2650

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005621720002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001202 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000070 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 219480 . This is a "COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 282755 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 219480 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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