MEDICARE: UPMC COMMUNITY MEDICINE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	OS005699L	PA

General Provider Information

NPI Number	:	1215078878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPMC COMMUNITY MEDICINE INC

Provider Business Mailing Address
First Line	:	5626 OBERLIN DR
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1705
Country	:	US
Telephone Number	:	858-625-2990
Fax Number	:	858-625-2999

Provider Business Practice Location Address
First Line	:	20130 ROUTE 19
Second Line	:	SUITE 1000
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-6218
Country	:	US
Telephone Number	:	724-779-5005
Fax Number	:	724-779-3278

Authorized Official
Title or Position	:	VPOF OPERATIONS
Name	:	KENNY HEINE
Credential	:
Telephone Number	:	858-625-2990

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/19/2013

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