Provider Demographics
NPI:1548292147
Name:EXTENDED CARE MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:EXTENDED CARE MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-375-3100
Mailing Address - Street 1:5824 LONGVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1277
Mailing Address - Country:US
Mailing Address - Phone:724-375-3100
Mailing Address - Fax:724-375-5858
Practice Address - Street 1:5824 LONGVIEW CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1277
Practice Address - Country:US
Practice Address - Phone:724-375-3100
Practice Address - Fax:724-375-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010424740001Medicaid
PA1608513OtherBLUE SHIELD
3567805OtherAETNA
OH2712425Medicaid
PAV0416BOtherUPMC
OH2712425Medicaid
PA1010424740001Medicaid