Provider Demographics
NPI:1164426896
Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Entity Type:Organization
Organization Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WILFONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-5013
Mailing Address - Street 1:600 GRANT STREET, US STEEL TOWER, 59TH FLOOR
Mailing Address - Street 2:C/O RENEE JOHNSON
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-2740
Mailing Address - Country:US
Mailing Address - Phone:412-623-6303
Mailing Address - Fax:412-623-6369
Practice Address - Street 1:4401 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-432-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PA291201282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
39330202OtherHEALTHAMERICA
0029OtherHIGHMARK BLUE CROSS BLUE
GA00311869XMedicaid
FL092432600Medicaid
PA22OtherUPMC COMMERCIAL
OH0010928Medicaid
PA1007347990059Medicaid
22OtherUPMC FOR KIDS
22OtherUPMC FOR YOU
46272OtherGATEWAY HEALTH PLAN
PA000000060304OtherUNISON HEALTH PLAN
0012586OtherAETNA
NY00429603Medicaid
WV0001649000Medicaid
NJ4201515Medicaid
PA000000060304OtherUNISON HEALTH PLAN
22OtherUPMC FOR KIDS
GA00311869XMedicaid