Provider Demographics
NPI:1437100765
Name:UPMC ALTOONA
Entity Type:Organization
Organization Name:UPMC ALTOONA
Other - Org Name:WILLIAMSBURG FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-889-2223
Mailing Address - Street 1:306 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-1116
Mailing Address - Country:US
Mailing Address - Phone:814-832-3405
Mailing Address - Fax:814-832-3811
Practice Address - Street 1:306 PLUM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693-1116
Practice Address - Country:US
Practice Address - Phone:814-832-3405
Practice Address - Fax:814-832-3811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC ALTOONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120138OtherHIGHMARK BC/BS
PA76160OtherUNISON HEALTH PLAN
PA1-54673328OtherGEISINGER HEALTH PLAN
PA719342OtherRAILROAD MEDICARE
PAV0P17OtherUPMC HEALTH PLAN
PA1007278290092Medicaid
PA1014434OtherGATEWAY HEALTH PLAN
PA111354OtherUNISON HEALTH PLAN OB
PA1007278290092Medicaid
PAV0P17OtherUPMC HEALTH PLAN