=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801062575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPMC COMMUNITY MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2008
-----------------------------------------------------
Last Update Date | 05/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 FIFTH AVE
-----------------------------------------------------
City | MCKEESPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15132-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-664-6755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 FIFTH AVE
-----------------------------------------------------
City | MCKEESPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15132-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MARK EHALT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-647-0943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------