Healthcare Provider Details

I. General information

NPI: 1598787590
Provider Name (Legal Business Name): UPMC MUNCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E WATER ST
MUNCY PA
17756-8828
US

IV. Provider business mailing address

600 GRANT STREET US STEEL TOWER 59TH FLOOR, C/O RENEE JOHNSON
PITTSBURGH PA
15219-2740
US

V. Phone/Fax

Practice location:
  • Phone: 570-546-4040
  • Fax: 570-326-8601
Mailing address:
  • Phone: 412-623-6303
  • Fax: 412-623-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number134302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number134302
License Number StatePA

VIII. Authorized Official

Name: ROGER C. YOST
Title or Position: CFO
Credential:
Phone: 570-321-3175