Healthcare Provider Details

I. General information

NPI: 1659626208
Provider Name (Legal Business Name): UNIVERSITY OF PITTSBURGH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11360 PERRY HWY
WEXFORD PA
15090-8371
US

IV. Provider business mailing address

11360 PERRY HWY
WEXFORD PA
15090-8371
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-9900
  • Fax:
Mailing address:
  • Phone: 724-935-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK EHALT
Title or Position: SR.DIRECTOR
Credential:
Phone: 412-647-0943