=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346544749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPMC COMMUNITY MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2010
-----------------------------------------------------
Last Update Date | 12/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 WILDLIFE LODGE RD SUITE 100
-----------------------------------------------------
City | LOWER BURRELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-3652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-334-2000
-----------------------------------------------------
Fax | 724-334-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 WILDLIFE LODGE RD SUITE 100
-----------------------------------------------------
City | LOWER BURRELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-3652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-334-2000
-----------------------------------------------------
Fax | 724-334-4500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR.DIRECTOR
-----------------------------------------------------
Name | MR. MARK T EHALT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-647-0943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------