Provider Demographics
NPI:1134309552
Name:UPMC HORIZON
Entity Type:Organization
Organization Name:UPMC HORIZON
Other - Org Name:UPMC HORIZON PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-588-0150
Mailing Address - Street 1:960 S HERMITAGE RD
Mailing Address - Street 2:P.O. BOX 1004
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3673
Mailing Address - Country:US
Mailing Address - Phone:724-347-0861
Mailing Address - Fax:724-347-0864
Practice Address - Street 1:875 N HERMITAGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3278
Practice Address - Country:US
Practice Address - Phone:724-347-4783
Practice Address - Fax:724-646-8289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC HORIZON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054180L207RG0100X
PAMD044146L207RI0200X
PAMD427828207RP1001X
PAMD428726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1433816OtherHIGHMARK BC/BS
PA0011763400008Medicaid
PA1015678190001Medicaid
PA1499299OtherHIGHMARK BC/BS
PA0015147500009Medicaid
PA1464693OtherHIGHMARK BC/BS
PA1876495OtherHIGHMARK BC/BS
PA1014980230002Medicaid
PA425122Medicare PIN
PA1876495OtherHIGHMARK BC/BS
PA1464693OtherHIGHMARK BC/BS