1639158488 NPI number — UPMC ALTOONA REGIONAL HEALTH SERVICES, INC

Table of content: (NPI 1639158488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639158488 NPI number — UPMC ALTOONA REGIONAL HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC ALTOONA REGIONAL HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLAIR MEDICAL ASSOCIATES
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 Information

NPI Number:
1639158488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 9TH AVE
Provider Second Line Business Mailing Address:
STATION MEDICAL CENTER
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16602-2454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-946-1655
Provider Business Mailing Address Fax Number:
814-949-7616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 9TH AVE
Provider Second Line Business Practice Location Address:
STATION MEDICAL CENTER
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-2454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-946-1655
Provider Business Practice Location Address Fax Number:
814-949-7616
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWAB
Authorized Official First Name:
JILL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
814-949-7622

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: MD439371 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: MD439371 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: MD436098 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: MD428424 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: MD026570E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0719120001 . This is a "DMERC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015582 . This is a "GATEWAY ENDO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000358443 . This is a "HIGHMARK PSYCHOLOGY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007393100018 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00148787610002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007393100022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028905 . This is a "HIGHMARK GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007393100001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1014409 . This is a "GATEWAY NEUROLOGY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015438 . This is a "GATEWAY SURGERY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015584 . This is a "GATEWAY DERM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015429 . This is a "GATEWAY PODIATRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 117185 . This is a "HIGHMARK PODIATRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007393100101 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1556762 . This is a "GATEWAY OB-GYN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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