Provider Demographics
NPI:1588600902
Name:UPMC MUNCY
Entity Type:Organization
Organization Name:UPMC MUNCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOCKHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-578-9592
Mailing Address - Street 1:1205 GRAMPIAN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1978
Mailing Address - Country:US
Mailing Address - Phone:570-326-8676
Mailing Address - Fax:570-326-8601
Practice Address - Street 1:215 E WATER ST
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8828
Practice Address - Country:US
Practice Address - Phone:570-546-8282
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC SUSQUEHANNA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA134301275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058074OtherFIRST PRIORITY HEALTH PIN
PA391301OtherHEALTH ASSURANCE PIN
PA000111OtherAMERIHEALTH ADMINSTR PIN
PA1004905OtherKEYSTONE MERCY HEALTH PIN
PA309502OtherBLACK LUNG PROGRAM PIN
PA391301OtherAETNA PIN
PA391301OtherHEALTH AMERICA PIN
PA20020966OtherAMERIHEALTH HMO AMER PIN
PA29430OtherGEISINGER HEALTH PLAN PIN
PA39Z301OtherBLUE CROSS PIN
PA058074OtherFIRST PRIORITY HEALTH PIN
PA39Z301Medicare Oscar/Certification