Healthcare Provider Details

I. General information

NPI: 1518089200
Provider Name (Legal Business Name): UPMC PRESBYTERIAN SHADYSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2593
US

IV. Provider business mailing address

PO BOX 382007
PITTSBURGH PA
15250-8007
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 Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BOBRZYNSKI
Title or Position: CFO
Credential: CFO
Phone: 412-246-6809