Provider Demographics
NPI:1073692679
Name:UPMC SOMERSET
Entity Type:Organization
Organization Name:UPMC SOMERSET
Other - Org Name:SOMERSET HOSPITAL SPU
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-443-5000
Mailing Address - Street 1:PO BOX 645819
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-5819
Mailing Address - Country:US
Mailing Address - Phone:814-443-5221
Mailing Address - Fax:814-443-4937
Practice Address - Street 1:225 S CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2088
Practice Address - Country:US
Practice Address - Phone:814-443-5221
Practice Address - Fax:814-443-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA196901261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002086660028Medicaid
PA390039Medicare Oscar/Certification