Healthcare Provider Details

I. General information

NPI: 1215558416
Provider Name (Legal Business Name): UPMC WESTERN MARYLAND CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HUNT CLUB DR
RIDGELEY WV
26753-7567
US

IV. Provider business mailing address

600 GRANT STREET, US STEEL TOWER, 59TH FLOOR C/O RENEE JOHNSON
PITTSBURGH PA
15219-1671
US

V. Phone/Fax

Practice location:
  • Phone: 304-726-4501
  • Fax: 304-726-4051
Mailing address:
  • Phone: 412-623-6303
  • Fax: 240-964-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER RUBLE
Title or Position: CFO
Credential:
Phone: 240-964-8032