MEDICARE: AMY R STINE ESTATE

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	174400000X	Specialist	MD036523E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250116	OTHER	PA	UPMC HEALTH PLAN

General Provider Information

NPI Number	:	1841252582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY R STINE ESTATE

Provider Business Mailing Address
First Line	:	8150 PERRY HWY
Second Line	:	SUITE 332
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5232
Country	:	US
Telephone Number	:	412-630-8250
Fax Number	:	412-630-8251

Provider Business Practice Location Address
First Line	:	8150 PERRY HWY
Second Line	:	SUITE 332
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5232
Country	:	US
Telephone Number	:	412-630-8250
Fax Number	:	412-630-8251

Authorized Official
Title or Position	:	ADMINISTRATOR OF ESTATE
Name	:	WILLIAM R. BROSE
Credential	:
Telephone Number	:	412-367-3849

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/17/2008

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Directions to “AMY R STINE ESTATE ” Practice Location

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