Provider Demographics
NPI:1194889485
Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Entity type:Organization
Organization Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WILFONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-5013
Mailing Address - Street 1:600 GRANT STREET, US STEEL TOWER, 59TH FLOOR
Mailing Address - Street 2:C/O RENEE JOHNSON
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-2740
Mailing Address - Country:US
Mailing Address - Phone:412-623-6303
Mailing Address - Fax:412-623-6369
Practice Address - Street 1:2599 WEXFORD BAYNE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143
Practice Address - Country:US
Practice Address - Phone:412-692-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08741500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000056144OtherUNISON CHIP
PA000000056144OtherUNISON HEALTH PLAN
PA1007347990004Medicaid