Healthcare Provider Details

I. General information

NPI: 1265845044
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 GALLERY DR
MC MURRAY PA
15317-2690
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 4
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-7300
  • Fax: 724-260-7310
Mailing address:
  • Phone: 412-330-5015
  • Fax: 412-330-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007317140447
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: PATRICK BENTON
Title or Position: PROVIDER CREDENTIALING SPECIALIST
Credential:
Phone: 412-330-5015