Provider Demographics
NPI:1033227111
Name:UPMC CHAUTAUQUA AT WCA
Entity Type:Organization
Organization Name:UPMC CHAUTAUQUA AT WCA
Other - Org Name:THE WOMAN'S CHRISTIAN ASSOCIATION OF JAMESTOWN NY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURNIOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-676-7146
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:207 FOOTE AVE.
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14702-0840
Mailing Address - Country:US
Mailing Address - Phone:716-485-7892
Mailing Address - Fax:716-487-1802
Practice Address - Street 1:207 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:716-487-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03130985Medicaid