Healthcare Provider Details

I. General information

NPI: 1346467776
Provider Name (Legal Business Name): MCCOLLUM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BELTZHOOVER AVE.
PITTSBURGH PA
15210
US

IV. Provider business mailing address

514 BELTZHOOVER AVE.
PITTSBURGH PA
15210
US

V. Phone/Fax

Practice location:
  • Phone: 412-431-3080
  • Fax: 412-431-6958
Mailing address:
  • Phone: 412-431-3080
  • Fax: 412-431-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GEORGE R. MCCOLLUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 412-431-3080