Basic Information
| Provider Information | |||||||||
| NPI: | 1114959632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGHENY HEALTHCARE NETWORK LLC | ||||||||
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| OtherOrganizationName: | KEYSTONE PAIN INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1699 WASHINGTON RD | ||||||||
| Address2: | STE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152281629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128313744 | ||||||||
| FaxNumber: | 4128315663 | ||||||||
| Practice Location | |||||||||
| Address1: | 3109 FAIRWAY DR | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166024475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149445835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | FINK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8149445835 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | RN229834L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.