Provider Demographics
NPI:1962754895
Name:UPMC WELLSBORO
Entity type:Organization
Organization Name:UPMC WELLSBORO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILFIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-724-1631
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 1:32-36 CENTRAL AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1840
Practice Address - Country:US
Practice Address - Phone:570-723-0160
Practice Address - Fax:570-724-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC WELLSBORO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography