Provider Demographics
NPI:1609801976
Name:UPMC WILLIAMSPORT
Entity Type:Organization
Organization Name:UPMC WILLIAMSPORT
Other - Org Name:WILLIAMSPORT REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-321-3175
Mailing Address - Street 1:600 GRANT ST, US STEEL TOWER, 59TH FLOOR
Mailing Address - Street 2:C/O RENEE JOHNSON
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-2740
Mailing Address - Country:US
Mailing Address - Phone:412-623-6303
Mailing Address - Fax:412-623-6369
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-1000
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234601261QA1903X, 261QF0050X, 261QP2300X, 282N00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017347OtherKEYSTONE MERCY HEALTH PIN
PA29796OtherGEISINGER HEALTH PLAN PIN
PA301400OtherBLACK LUNG PROGRAM PIN
PA390045OtherHEALTH ASSURANCE PIN
PA390045OtherHEALTH AMERICA PIN
PA20007166OtherAMERIHEALTH HMO AMER PIN
PA074006OtherFIRST PRIORITY HEALTH PIN
PA390045OtherAETNA PIN
PA000109OtherAMERIHEALTH ADMINIST PIN
PA1007548350019Medicaid
PA390045OtherBLUE CROSS PIN
PA1007548350019Medicaid
PA390045Medicare Oscar/Certification