Provider Demographics
NPI:1457303885
Name:UPMC ALTOONA
Entity Type:Organization
Organization Name:UPMC ALTOONA
Other - Org Name:WOMEN'S HEALTH AND WELLNESS
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 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE F2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:814-889-2012
Mailing Address - Fax:814-889-7864
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE F2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-889-2012
Practice Address - Fax:814-889-7864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC ALTOONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012801261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278290010Medicaid
PA03-030OtherPPA NUMBER-SDT PROGRAM
PAPENDINGOtherFAMILY HEALTH COUNCIL
PA03-030OtherPPA NUMBER-SDT PROGRAM