| Life Male Science Technology Engineering Arts And Math Academy | |
|
777 Penn Center Blvd Penn Hills PA 15235-5927 | |
| (412) 745-5433 | |
| Not Available |
| Full Name | Life Male Science Technology Engineering Arts And Math Academy |
|---|---|
| Speciality | Nurse Practitioner - School |
| Location | 777 Penn Center Blvd, Penn Hills, Pennsylvania |
| Authorized Official Name and Position | Darryl Canady (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2522661111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Male Science Technology Engineering Arts And Math Academy 11888 Palomino Ct North Huntingdon PA 15642-6712 Ph: (252) 266-1111 | Life Male Science Technology Engineering Arts And Math Academy 777 Penn Center Blvd Penn Hills PA 15235-5927 Ph: (412) 745-5433 |
| NPI Number | 1568121655 |
|---|---|
| Provider Enumeration Date | 12/15/2021 |
| Last Update Date | 01/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568121655 | NPI | - | NPPES |
| 1750548665 | Medicaid | RI | |
| 1912070988 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LS0200X | Nurse Practitioner - School | (* (Not Available)) | Primary |