Provider Demographics
NPI:1710017025
Name:COLAIZZI PEDORTHIC CENTER
Entity type:Organization
Organization Name:COLAIZZI PEDORTHIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOWATIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-748-0252
Mailing Address - Street 1:107 MOUNT NEBO POINTE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1315
Mailing Address - Country:US
Mailing Address - Phone:412-748-0252
Mailing Address - Fax:412-748-0259
Practice Address - Street 1:617 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3112
Practice Address - Country:US
Practice Address - Phone:412-761-8100
Practice Address - Fax:412-761-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVOT560OtherUPMC HEALTH PLAN
PA01730343Medicaid
PA208657OtherBLUE CROSS BLUE SHIELD
PA01730343Medicaid