1215078878 NPI number — UPMC COMMUNITY MEDICINE INC

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 1215078878 NPI number — UPMC COMMUNITY MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC COMMUNITY MEDICINE 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:
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:
1215078878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5626 OBERLIN DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-625-2990
Provider Business Mailing Address Fax Number:
858-625-2999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20130 ROUTE 19
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
CRANBERRY TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-779-5005
Provider Business Practice Location Address Fax Number:
724-779-3278
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEINE
Authorized Official First Name:
KENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
VPOF OPERATIONS
Authorized Official Telephone Number:
858-625-2990

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  OS005699L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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