Healthcare Provider Details

I. General information

NPI: 1134309552
Provider Name (Legal Business Name): UPMC HORIZON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N HERMITAGE RD SUITE 4
HERMITAGE PA
16148-3278
US

IV. Provider business mailing address

960 S HERMITAGE RD P.O. BOX 1004
HERMITAGE PA
16148-3673
US

V. Phone/Fax

Practice location:
  • Phone: 724-347-4783
  • Fax: 724-646-8289
Mailing address:
  • Phone: 724-347-0861
  • Fax: 724-347-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD054180L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD044146L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD427828
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD428726
License Number StatePA

VIII. Authorized Official

Name: DAVID SHULIK
Title or Position: CFO
Credential:
Phone: 724-588-0150