Basic Information
| Provider Information | |||||||||
| NPI: | 1417921743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGHENY MEDICAL PRACTICE NETWORK | ||||||||
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| OtherOrganizationName: | ALLE-KISKI WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3063 FREEPORT RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150651967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242262392 | ||||||||
| FaxNumber: | 7242262498 | ||||||||
| Practice Location | |||||||||
| Address1: | 3063 FREEPORT RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150651967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242262392 | ||||||||
| FaxNumber: | 7242262498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | WALTEMIRE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGED CARE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4123305523 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0017600750028 | 05 | PA | MEDICAID |