Healthcare Provider Details

I. General information

NPI: 1215053939
Provider Name (Legal Business Name): UPMC COMMUNITY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S 5TH AVE
CLARION PA
16214-6010
US

IV. Provider business mailing address

342 SOUTH FIFTH AVE
CLARION PA
16124
US

V. Phone/Fax

Practice location:
  • Phone: 814-797-1126
  • Fax:
Mailing address:
  • Phone: 814-797-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1382587
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK GROUP

VIII. Authorized Official

Name: MARK EHALT
Title or Position: DIRECTOR
Credential:
Phone: 412-647-0943