1841267275 NPI number — SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI

Table of content: (NPI 1841267275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841267275 NPI number — SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI
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:
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:
1841267275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 HOT METAL ST
Provider Second Line Business Mailing Address:
QUANTUM ONE, N430
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15203-2348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-432-7706
Provider Business Mailing Address Fax Number:
412-432-7691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CORAOPOLIS HEIGHTS RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
MOON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-329-2500
Provider Business Practice Location Address Fax Number:
412-329-2540
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOGOSTA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT - CANCER SERVICES
Authorized Official Telephone Number:
412-692-2451

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  39D1027607 , registered in the state of PA ; 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: "Y" .

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

  • Identifier: 951583 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018806270007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018806270008 . This is a "CLIA LAB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2517655 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810011966 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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