Provider Demographics
NPI:1568023687
Name:UPMC CHAUTAUQUA AT WCA
Entity Type:Organization
Organization Name:UPMC CHAUTAUQUA AT WCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:DINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-877-3739
Mailing Address - Street 1:207 FOOTE AVE.
Mailing Address - Street 2:FINANCE DEPARTMENT
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7077
Mailing Address - Country:US
Mailing Address - Phone:716-485-7892
Mailing Address - Fax:716-487-1802
Practice Address - Street 1:51 GLASGOW AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6440
Practice Address - Country:US
Practice Address - Phone:716-487-0141
Practice Address - Fax:716-487-1802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC CHAUTAUQUA AT WCA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit