Healthcare Provider Details

I. General information

NPI: 1972038826
Provider Name (Legal Business Name): UPMC CARLISLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 ALEXANDER SPRING RD
CARLISLE PA
17015-6940
US

IV. Provider business mailing address

361 ALEXANDER SPRING RD
CARLISLE PA
17015-6940
US

V. Phone/Fax

Practice location:
  • Phone: 717-960-3354
  • Fax:
Mailing address:
  • Phone: 717-960-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103355781
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: PATRICE A TALEFF
Title or Position: VP, REVENUE CYCLE
Credential:
Phone: 717-230-3790