Basic Information
| Provider Information | |||||||||
| NPI: | 1386992592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. CLAIR MEDICAL SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOHNSTON INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422672 | ||||||||
| FaxNumber: | 4129422689 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 OXFORD DR | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151021827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124713061 | ||||||||
| FaxNumber: | 4124716621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2012 | ||||||||
| LastUpdateDate: | 08/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHESNOS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4129421250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. CLAIR HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.