Healthcare Provider Details

I. General information

NPI: 1194889485
Provider Name (Legal Business Name): UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2599 WEXFORD BAYNE RD
SEWICKLEY PA
15143
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: 412-692-7337
  • Fax:
Mailing address:
  • Phone: 412-623-6303
  • Fax: 412-623-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number08741500
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier000000056144
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON CHIP
# 2
Identifier000000056144
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON HEALTH PLAN

VIII. Authorized Official

Name: MR. MARIO WILFONG
Title or Position: CFO
Credential:
Phone: 412-692-5013