Healthcare Provider Details
I. General information
NPI: 1831108489
Provider Name (Legal Business Name): UPMC BRADDOCK
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/05/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
400 HOLLAND AVE
BRADDOCK PA
15104-1599
US
IV. Provider business mailing address
PO BOX 382007
PITTSBURGH PA
15250-8007
US
V. Phone/Fax
- Phone: 412-432-5500
- Fax:
- Phone: 412-432-5500
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 282N00000X |
| Taxonomy | General Acute Care Hospital |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 35 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | UPMC FOR YOU NUMBER |
| # 2 | |
| Identifier | 4196007 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 3 | |
| Identifier | 0006490105 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA US HEALTHCARE NUMBE |
| # 4 | |
| Identifier | 0080000 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA HMO NUMBER |
| # 5 | |
| Identifier | 00814902 |
| Identifier Type | MEDICAID |
| Identifier State | NY |
| Identifier Issuer | |
| # 6 | |
| Identifier | 0101249 |
| Identifier Type | MEDICAID |
| Identifier State | WV |
| Identifier Issuer | |
| # 7 | |
| Identifier | 390176 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HEALTHAMERICA NUMBER |
| # 8 | |
| Identifier | 7061889 |
| Identifier Type | MEDICAID |
| Identifier State | OH |
| Identifier Issuer | |
| # 9 | |
| Identifier | 1007360690006 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 0002 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK PROVIDER NUMBER |
| # 11 | |
| Identifier | 00000060222 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | MEDPLUS NUMBER |
| # 12 | |
| Identifier | 1005242 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GATEWAY NUMBER |
| # 13 | |
| Identifier | 1007360690006 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | ION HEALTHCARE NUMBER |
| # 14 | |
| Identifier | 35 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | UPMC HEALTH PLAN NUMBER |
VIII. Authorized Official
Name: MRS.
SUSAN
MAMMARELLA
Title or Position: CFO
Credential: CFO
Phone: 412-636-5314
