NPIMap

Organization Active NPI

East Liberty Family Health Care Center, Inc.

Doing business as East Liberty Family Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Pittsburgh, PA
National Provider Identifier
1164948733
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Doing business as
East Liberty Family Health Care Center
Practice address
1425 Forbes Ave FL 2
Pittsburgh, PA 15219-5140
Phone
(412) 345-0412
Fax
(412) 661-2802
NPI assigned
Aug 16, 2017
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian J King
Title
Cfo
Phone
(412) 345-0412

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1425 Forbes Ave FL 2
Pittsburgh, PA 15219-5140

Mailing address

7157 Mary Peck Bond PL
Pittsburgh, PA 15206-1236
Phone (412) 345-0412

Other names 1

  • East Liberty Family Health Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040825000501 PA Part B Supplier - Clinic/Group Practice 2163496084 Receives reassigned benefits from 56 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pittsburgh, PA
O20180307002384 PA Part A Provider - Federally Qualified Health Center (FQHC) 2163496084 Practice locations: Pittsburgh, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164948733. Details of each certification follow.

Federally qualified health center certification: CCN 391107

Legal name
EAST LIBERTY FAMILY HEALTH CARE CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 28, 2018
Last certification
Feb 28, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1982 in PA
Enrollment address
1425 Forbes Ave
FL 2
Pittsburgh, PA 15219

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
East Liberty Fam HLTH C4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6023 Harvard St
Pittsburgh, PA 15206
Phone (412) 361-8284

7157 Mary Peck Bond Pl
Pittsburgh, PA 15206
Phone (412) 345-0412

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brian King Individual 5% Or Greater Direct Ownership Interest Jun 1, 2022
5% Or Greater Indirect Ownership Interest Jun 1, 2022
Alice Keister Individual W-2 Managing EmployeeDirector of Patient Registration an Apr 4, 2016
Sean Michael Conroy Individual Corporate DirectorBoard Member Aug 27, 2012
Kathy Mayle-Towns Individual Corporate OfficerPresident Feb 15, 2010
Steve Paff Individual Corporate OfficerSecretary Aug 25, 2014
Angelica Cooper Individual Corporate DirectorBoard Member Aug 25, 2014
David George Hall Individual Contracted Managing EmployeeMedical Director Jul 1, 1982
Corporate DirectorMedical Director Jul 1, 1982
Michael Smith Individual Corporate DirectorBoard Member Aug 25, 2014
Paul Roberts Individual Corporate DirectorBoard Member Nov 5, 2010
Diana Armstrong Individual Corporate DirectorBoard Member Sep 23, 2013
Mattie Woods Individual Corporate DirectorBoard Member Jul 1, 2012
Leon R Williams Individual Contracted Managing EmployeeDental Director Jan 19, 2016
Corporate DirectorDental Director Jan 19, 2016
Georgette Powell Individual Corporate OfficerVice President Nov 5, 2010

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1164948733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7157 MARY PECK BOND PL",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152061236",
            "telephone_number": "412-345-0412",
            "fax_number": "412-661-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 FORBES AVE FL 2",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152195140",
            "telephone_number": "412-345-0412",
            "fax_number": "412-661-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "412-345-0412"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Liberty Family Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.