Provider Demographics
NPI:1093890360
Name:UPMC WILLIAMSPORT
Entity type:Organization
Organization Name:UPMC WILLIAMSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA FHFMA
Authorized Official - Phone:570-321-3171
Mailing Address - Street 1:1205 GRAMPIAN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1978
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
PA2346013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20007166OtherAMERIHEALTH HMO AMER PIN
PA1017347OtherKEYSTONE MERCY HEALTH PIN
PA074006OtherFIRST PRIORITY HEALTH PIN
PA1007548350010Medicaid
PA301400OtherBLACK LUNG PROGRAM PIN
PA390045OtherAETNA PIN
PA000109OtherAMERIHEALTH ADMINST PIN
PA29796OtherGEISINGER HEALTH PLAN PIN
PA390045OtherHEALTH AMERICA PIN
PA390045OtherHEALTH ASSURANCE PIN
PA390045OtherBLUE CROSS PIN
PA=========OtherMAILHANDLERS BENEFIT PIN
PA20007166OtherAMERIHEALTH HMO AMER PIN