Basic Information
| Provider Information | |||||||||
| NPI: | 1255366100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENAISSANCE FAMILY PRACTICE, INC | ||||||||
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| OtherOrganizationName: | RFP/PENN HILLS DIVISON | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WATERCREST WAY | ||||||||
| Address2: | SUITE 630 | ||||||||
| City: | CHESWICK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150241370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242749451 | ||||||||
| FaxNumber: | 7242749370 | ||||||||
| Practice Location | |||||||||
| Address1: | 5769 SALTSBURG RD | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151473211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127938870 | ||||||||
| FaxNumber: | 4127939290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZANOTTI | ||||||||
| AuthorizedOfficialFirstName: | MARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7242749451 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 178668 | 01 | PA | HIGHMARK DIVISION | OTHER |