Basic Information
| Provider Information | |||||||||
| NPI: | 1053426593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST PENN ALLEGHENY HEALTH SYSTEM, INC. | ||||||||
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| OtherOrganizationName: | THE FOOT AND ANKLE INSTITUTE OF W. PA. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2570 HAYMAKER RD OFC BLDG1 | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128587699 | ||||||||
| FaxNumber: | 4128587696 | ||||||||
| Practice Location | |||||||||
| Address1: | 3058 LEECHBURG RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | LOWER BURRELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150683460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243379977 | ||||||||
| FaxNumber: | 7243379976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 12/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | MENDICINO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4128587691 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1007277200089 | 05 | PA | MEDICAID |