Provider Demographics
NPI:1588698922
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 ST
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:570-321-2600
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234601273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000109OtherAMERIHEALTH ADMISTR PIN
PA390045OtherHEALTH ASSURANCE PIN
PA20007166OtherAMERIHEALTH HMO AMER PIN
PA301400OtherBLACK LUNG PROGRAM PIN
PA390045OtherAETNA PIN
PA39T045OtherBLUE CROSS PIN
PA074006OtherFIRST PRIORITY HEALTH PIN
PA29796OtherGEISINGER HEALTH PLAN PIN
PA390045OtherMC TRAVELERS (RAILRD PIN
PA1007548350022Medicaid
PA390045OtherHEALTH AMERICA PIN
PA1017347OtherKEYSTONE MERCY HEALTH PIN
PA1007548350022Medicaid
PA390045OtherMC TRAVELERS (RAILRD PIN