| |
5770 Baum Blvd Ste 100 Pittsburgh PA 15206 | |
(412) 661-0400 | |
(412) 661-1803 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5770 Baum Blvd Ste 100, Pittsburgh, Pennsylvania |
Authorized Official Name and Position | Tasheda Broughton (CRED MANAGER) |
Authorized Official Contact | 2522483313 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2122 York Rd Ste 300 Oak Brook IL 60523-1925 Ph: (252) 248-3313 | 5770 Baum Blvd Ste 100 Pittsburgh PA 15206 Ph: (412) 661-0400 |
NPI Number | 1144262635 |
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Provider Enumeration Date | 06/11/2006 |
Last Update Date | 12/03/2024 |
Certification Date | 12/03/2024 |
Medicare PECOS PAC ID | 9032020599 |
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Medicare Enrollment ID | O20040120000127 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144262635 | NPI | - | NPPES |
001478369 | Medicaid | PA | |
396539 | Other | PA | BUREAU OF WORKERS COMP |
80420 | Other | PA | AETNA |
13591 | Other | PA | HEALTH AMERICA |
1500905 | Other | PA | GATEWAY |
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