1134309552 NPI number — UPMC HORIZON

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134309552 NPI number — UPMC HORIZON

Employer Identification Number (EIN):

Provider Organization Name:

UPMC HORIZON

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

UPMC HORIZON PHYSICIANS

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1134309552

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

11/29/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

960 S HERMITAGE RD

Provider Second Line Business Mailing Address:

P.O. BOX 1004

Provider Business Mailing Address City Name:

HERMITAGE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

16148-3673

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

724-347-0861

Provider Business Mailing Address Fax Number:

724-347-0864

Provider First Line Business Practice Location Address:

875 N HERMITAGE RD

Provider Second Line Business Practice Location Address:

SUITE 4

Provider Business Practice Location Address City Name:

HERMITAGE

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

16148-3278

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-347-4783

Provider Business Practice Location Address Fax Number:

724-646-8289

Provider Enumeration Date:

11/14/2007

Authorized Official Last Name:

SHULIK

Authorized Official First Name:

DAVID

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

724-588-0150

• Taxonomy code: 207RG0100X , with the licence number:  MD054180L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RI0200X , with the licence number: MD044146L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: MD427828 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X , with the licence number: MD428726 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1433816 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0011763400008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015678190001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1499299 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0015147500009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1464693 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1876495 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1014980230002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".