Basic Information
| Provider Information | |||||||||
| NPI: | 1457781411 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH HILLS REHAB ASSOC. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 COAL VALLEY RD | ||||||||
| Address2: | SUITE 277 | ||||||||
| City: | JEFFERSON HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124697722 | ||||||||
| FaxNumber: | 4124697721 | ||||||||
| Practice Location | |||||||||
| Address1: | EASTGATE 8 | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | MONESSEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150621392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246848670 | ||||||||
| FaxNumber: | 4124697721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2013 | ||||||||
| LastUpdateDate: | 03/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | MEHTA | ||||||||
| AuthorizedOfficialFirstName: | RAJESH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4124697722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | MD052535L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007508090003 | 05 | PA | MEDICAID | 1398027 | 01 | PA | BLUE SHIELD GROUP ID | OTHER | 1526169 | 01 | PA | GATEWAY GROUP ID | OTHER | 187802 | 01 | PA | HEALTH AMERICA | OTHER |