MEDICARE: WHITE OAK MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD033987L	PA

General Provider Information

NPI Number	:	1053470500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE OAK MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1949 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-2401
Country	:	US
Telephone Number	:	412-672-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1949 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-2401
Country	:	US
Telephone Number	:	412-672-6800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHAMMAD IDREES
Credential	:	MD
Telephone Number	:	412-672-6800

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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