Provider Demographics
NPI:1457317455
Name:UPMC WESTERN MARYLAND CORPORATION
Entity Type:Organization
Organization Name:UPMC WESTERN MARYLAND CORPORATION
Other - Org Name:WESTERN MARYLAND HEALTH SYSTEM HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP VFO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-964-8032
Mailing Address - Street 1:1050 W INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4331
Mailing Address - Country:US
Mailing Address - Phone:240-964-9000
Mailing Address - Fax:240-964-8337
Practice Address - Street 1:1050 W INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4331
Practice Address - Country:US
Practice Address - Phone:240-964-9000
Practice Address - Fax:204-964-8337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC WESTERN MARYLAND CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1534251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64875201OtherBLUE CROSS BLUE SHIELD
MD794092106Medicaid
MD64875201OtherBLUE CROSS BLUE SHIELD