Healthcare Provider Details

I. General information

NPI: 1174187801
Provider Name (Legal Business Name): UPMC COMMUNITY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BEAVER DR
DU BOIS PA
15801-2425
US

IV. Provider business mailing address

89 BEAVER DR
DU BOIS PA
15801-2425
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-4524
  • Fax: 814-371-0331
Mailing address:
  • Phone: 814-371-4524
  • Fax: 814-371-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DEVLIN
Title or Position: DIRECTOR
Credential:
Phone: 412-432-7469