=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912033044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPMC COMMUNITY MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 01/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 SHENANGO ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16125-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-588-4240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 SHENANGO ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16125-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-588-4240
-----------------------------------------------------
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 | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------