1821055393 NPI number — UPMC WESTERN MARYLAND CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821055393 NPI number — UPMC WESTERN MARYLAND CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC WESTERN MARYLAND CORPORATION
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:
Provider Other Organization Name Type Code:
6
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:
1821055393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 W INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-9100
Provider Business Mailing Address Fax Number:
240-964-9101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 W INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-4331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-9108
Provider Business Practice Location Address Fax Number:
240-964-8851
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUBLE
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SR. VP CFO
Authorized Official Telephone Number:
240-964-8032

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH7031 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 229113 . This is a "ALLIANCE MAMSI MDIPA OPCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59010101 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MB5 . This is a "BLUE CHOICE FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: SA7 . This is a "BLUE CHOICE FED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001768001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000463400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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