Provider Demographics
NPI:1053356436
Name:EDGEWORTH COMMONS GROUP LLC
Entity type:Organization
Organization Name:EDGEWORTH COMMONS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA
Authorized Official - Phone:412-741-1170
Mailing Address - Street 1:301 OHIO RIVER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1300
Mailing Address - Country:US
Mailing Address - Phone:412-741-1170
Mailing Address - Fax:
Practice Address - Street 1:301 OHIO RIVER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-741-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1777261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00265162OtherRAILROAD MEDICARE
PAHIGHMARKOther0258
PA000000168322OtherUNISON
PA2787108OtherCIGNA
PA1013391430001Medicaid
PA000000168322OtherUNISON
PA1013391430001Medicaid