Healthcare Provider Details

I. General information

NPI: 1932356201
Provider Name (Legal Business Name): WEST PENN PHYSICIAN PRACTICE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PENNSYLVANIA AVE
IRWIN PA
15642-3552
US

IV. Provider business mailing address

100 PENNSYLVANIA AVE
IRWIN PA
15642-3552
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-1204
  • Fax: 724-863-9169
Mailing address:
  • Phone: 724-863-1204
  • Fax: 724-863-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CECILI R JONES
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 412-330-4813