Healthcare Provider Details

I. General information

NPI: 1386725182
Provider Name (Legal Business Name): UPMC CHAUTAUQUA AT WCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

PO BOX 840 207 FOOTE AVE.
JAMESTOWN NY
14702-0840
US

V. Phone/Fax

Practice location:
  • Phone: 716-487-0141
  • Fax:
Mailing address:
  • Phone: 716-485-7892
  • Fax: 716-487-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY NELSON DINGER
Title or Position: CFO
Credential:
Phone: 814-877-3739