Provider Demographics
NPI:1427025840
Name:UNIVERSITY OF PITTSBURGH CANCER INSTITUTE CANCER SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY OF PITTSBURGH CANCER INSTITUTE CANCER SERVICES
Other - Org Name:UPMC CANCER CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:TERWILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-623-7976
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-7706
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:5115 CENTRE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1301
Practice Address - Country:US
Practice Address - Phone:412-235-1020
Practice Address - Fax:412-235-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 207RH0003X, 2085R0001X
PAMD421423208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001464891OtherHIGHMARK
OH293383Medicaid
WV3810001950Medicaid
WV3810008543Medicaid
PA090348OtherMEDICARE IDTF
PA100747231Medicaid
PA1370903OtherHIGHMARK
PA1347736OtherHIGHMARK
PA001427691OtherHIGHMARK
OH2589962Medicaid
PACJ4604Medicare UPIN
WV3810008543Medicaid
WV3810001950Medicaid
PA1347736OtherHIGHMARK
PA090348OtherMEDICARE IDTF