=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316201064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPMC HORIZON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2012
-----------------------------------------------------
Last Update Date | 06/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 STERLING AVE APT A209
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16146-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-669-8361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 STERLING AVE APT A209
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16146-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENT
-----------------------------------------------------
Name | VU NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-669-8361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | OT014877
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------