1902023351 NPI number — WENDY M. MCSPARREN, LLC

Table of content: (NPI 1902023351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902023351 NPI number — WENDY M. MCSPARREN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDY M. MCSPARREN, 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:
1902023351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2282 ELMHILL RD
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:
15221-3664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-953-4151
Provider Business Mailing Address Fax Number:
724-733-3498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4115 WILLIAM PENN HWY STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15668-1887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-733-3491
Provider Business Practice Location Address Fax Number:
724-733-7498
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCSPARREN
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER & CEO
Authorized Official Telephone Number:
724-733-3491

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  CW012369 , 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: 001906302 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 664198 . This is a "HIGHMARK PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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