Provider Demographics
NPI:1538242052
Name:SHADYSIDE CARDIOLOGY ROTATION PC
Entity type:Organization
Organization Name:SHADYSIDE CARDIOLOGY ROTATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-820-0570
Mailing Address - Street 1:PO BOX 641671
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-1671
Mailing Address - Country:US
Mailing Address - Phone:412-820-0570
Mailing Address - Fax:412-820-4477
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:UPMC SHADYSIDE HOSPITAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-820-0570
Practice Address - Fax:412-820-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASH103248OtherBLUE CROSS OF WESTERN PA
PASH103248Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER