1437100765 NPI number — UPMC ALTOONA

Table of content: (NPI 1437100765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437100765 NPI number — UPMC ALTOONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC ALTOONA
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:
WILLIAMSBURG FAMILY PRACTICE
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:
1437100765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 PLUM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16693-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-832-3405
Provider Business Mailing Address Fax Number:
814-832-3811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 PLUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16693-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-832-3405
Provider Business Practice Location Address Fax Number:
814-832-3811
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-889-2223

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  012801 , 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)

  • Identifier: 120138 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76160 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1-54673328 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 719342 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: V0P17 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007278290092 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1014434 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 111354 . This is a "UNISON HEALTH PLAN OB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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