Healthcare Provider Details

I. General information

NPI: 1780776294
Provider Name (Legal Business Name): HEALTH ASSOCIATES OF WESTERN PENNSYLVANIA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JACKSON AVE 5TH FLOOR
PITTSBURGH PA
15202-3428
US

IV. Provider business mailing address

PO BOX 1236
BUTLER PA
16003-1236
US

V. Phone/Fax

Practice location:
  • Phone: 412-415-1138
  • Fax: 412-301-0113
Mailing address:
  • Phone: 412-937-9640
  • Fax: 412-937-8639

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
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052916
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002042L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP005003B
License Number StatePA

VIII. Authorized Official

Name: WILLIAM KEITH JOHNJULIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 412-415-1138