Provider Demographics
NPI:1144351867
Name:ORTHOPAEDIC SPINE SPECIALISTS OF WESTERN PA, P.C.
Entity type:Organization
Organization Name:ORTHOPAEDIC SPINE SPECIALISTS OF WESTERN PA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:LA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-391-5544
Mailing Address - Street 1:425 FIRST AVENUE AT CHERRY WAY
Mailing Address - Street 2:HARTLEY ROSE BUILDING, 4TH FLOOR
Mailing Address - City:PITTSGURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-1321
Mailing Address - Country:US
Mailing Address - Phone:412-391-5544
Mailing Address - Fax:412-391-5422
Practice Address - Street 1:425 FIRST AVENUE AT CHERRY WAY
Practice Address - Street 2:HARTLEY ROSE BUILDING, 4TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-1321
Practice Address - Country:US
Practice Address - Phone:412-391-5544
Practice Address - Fax:412-391-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023955E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009489250001Medicaid
PA0009489250001Medicaid
PA794390Medicare ID - Type Unspecified