1700800331 NPI number — LIFELINE CENTERS PC

Table of content: (NPI 1700800331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700800331 NPI number — LIFELINE CENTERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFELINE CENTERS PC
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:
1700800331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1525 PARK MANOR BLVD STE 308
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:
15205-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-351-6545
Provider Business Mailing Address Fax Number:
412-351-6547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 ARDMORE BLVD
Provider Second Line Business Practice Location Address:
251
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15221-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-351-6545
Provider Business Practice Location Address Fax Number:
412-273-1958
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIPLEY
Authorized Official First Name:
DAYNA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
412-351-6545

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117507 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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