=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770620775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAPHS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 PLEASANT DR
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-9551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-745-5258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7180 HIGHLAND DR
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-688-6235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HUMAN RESOURCES
-----------------------------------------------------
Name | KAREN HARRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-365-9690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | RN315429L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------