Healthcare Provider Details

I. General information

NPI: 1912972563
Provider Name (Legal Business Name): ALLEGHENY MEDICAL PRACTICE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GALLERY DR SUITE 300
MC MURRAY PA
15317-2690
US

IV. Provider business mailing address

160 GALLERY DR SUITE 300
MC MURRAY PA
15317-2690
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-7144
  • Fax: 724-941-7625
Mailing address:
  • Phone: 724-941-7144
  • Fax: 724-941-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017600750028
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CINDY WALTEMIRE
Title or Position: MANAGED CARE SPECIALIST
Credential:
Phone: 412-330-5523