Healthcare Provider Details

I. General information

NPI: 1639636533
Provider Name (Legal Business Name): UPMC WELLSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32-36 CENTRAL AVE
WELLSBORO PA
16901-1840
US

IV. Provider business mailing address

32-36 CENTRAL AVE
WELLSBORO PA
16901-1840
US

V. Phone/Fax

Practice location:
  • Phone: 570-723-0285
  • Fax: 570-723-0283
Mailing address:
  • Phone: 570-723-0104
  • Fax: 570-723-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANIE HILFIGER
Title or Position: PRESIDENT
Credential:
Phone: 570-723-0100