Basic Information
| Provider Information | |||||||||
| NPI: | 1770103723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEEL CITY SPINE AND ORTHOPEDIC CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791 | ||||||||
| Address2: | |||||||||
| City: | CARNEGIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151060791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126554362 | ||||||||
| FaxNumber: | 4126537684 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 HECKEL RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122066770 | ||||||||
| FaxNumber: | 7249415027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | BILLINGS | ||||||||
| AuthorizedOfficialFirstName: | KRISTYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 4126554362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | OS017370 | 01 | PA | STATE LICENSE | OTHER |