Provider Demographics
NPI:1063597334
Name:UPMC WILLIAMSPORT
Entity type:Organization
Organization Name:UPMC WILLIAMSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-578-9592
Mailing Address - Street 1:777 RURAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-326-8676
Mailing Address - Fax:570-326-8601
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-321-1000
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234601261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007548350033Medicaid