MEDICARE: CENTER FOR RENAL CARE AT SHADYSIDE, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1366502262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR RENAL CARE AT SHADYSIDE, LTD

Provider Business Mailing Address
First Line	:	440 S. FAIRMOUNT ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232
Country	:	US
Telephone Number	:	412-661-7026
Fax Number	:

Provider Business Practice Location Address
First Line	:	5511 BAUM BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1203
Country	:	US
Telephone Number	:	412-661-7026
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. J. GREGORY CAUTERUCCI SR.
Credential	:	NHA
Telephone Number	:	412-661-7026

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	01/14/2008

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