1871864397 NPI number — COLTRX, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871864397 NPI number — COLTRX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLTRX, 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:
1871864397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 MOUNT LEBANON BLVD
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15234-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-561-1499
Provider Business Mailing Address Fax Number:
412-561-1998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 HILLPOINTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANONSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-561-1499
Provider Business Practice Location Address Fax Number:
855-262-2143
Provider Enumeration Date:
01/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PITZARELLA
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
412-295-3363

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PP482202 , 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: 2133437 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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