Basic Information
| Provider Information | |||||||||
| NPI: | 1124092887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGHENY MEDICAL PRACTICE NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CRAFTON MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WALSH RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152052336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129223773 | ||||||||
| FaxNumber: | 4129226093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WALSH RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152052336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129223773 | ||||||||
| FaxNumber: | 4129226093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | WALTEMIRE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGED CARE SPEICLIST | ||||||||
| AuthorizedOfficialTelephone: | 4123305523 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25138457 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0017600750028 | 05 | PA | MEDICAID |