Healthcare Provider Details

I. General information

NPI: 1114937737
Provider Name (Legal Business Name): UPMC MCKEESPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

PO BOX 382007
PITTSBURGH PA
15251-8007
US

V. Phone/Fax

Practice location:
  • Phone: 412-432-5500
  • Fax:
Mailing address:
  • Phone: 412-432-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier840
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK PROVIDER NUMBER
# 2
Identifier117
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC HEALTH PLAN NUMBER

VIII. Authorized Official

Name: LAURENE TIMMONS
Title or Position: CFO
Credential:
Phone: 412-664-6781