Provider Demographics
NPI:1285719559
Name:UPMC WILLIAMSPORT
Entity type:Organization
Organization Name:UPMC WILLIAMSPORT
Other - Org Name:
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 1:600 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:
Practice Address - Street 1:700 HIGH STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-1000
Practice Address - Fax:570-321-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234601261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007548350014Medicaid
PA20007166OtherAMERIHEALTH HMO AMER PIN
PA29796OtherGEISINGER HEALTH PLAN PIN
PA390045OtherBLUE CROSS PIN
PA390045OtherAETNA PIN
PA074006OtherFIRST PRIORITY HEALTH PIN
PA390045OtherHEALTH ASSURANCE PIN
PA390045OtherHEALTH AMERICA PIN
PA1017347OtherKEYSTONE MERCY HEALTH PIN
PA301400OtherBLACK LUNG PROGRAM PIN
PA000109OtherAMERIHEALTH ADMINSTR PIN
PA390045OtherBLUE CROSS PIN
PA390045OtherHEALTH ASSURANCE PIN