Basic Information
| Provider Information | |||||||||
| NPI: | 1730518366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. CLAIR MEDICAL SERVICES, INC. | ||||||||
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| OtherOrganizationName: | TUCKER ORTHOPEDICS DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL RD | ||||||||
| Address2: | AFFILIATE BILLING | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422533 | ||||||||
| FaxNumber: | 4129422589 | ||||||||
| Practice Location | |||||||||
| Address1: | 1082 BOWER HILL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122766241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHESNOS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4129421250 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. CLAIR HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.