Provider Demographics
NPI:1609816198
Name:UPMC MUNCY
Entity Type:Organization
Organization Name:UPMC MUNCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-578-9592
Mailing Address - Street 1:600 GRANT STREET US STEEL TOWER
Mailing Address - Street 2:59TH FLOOR, 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 1:215 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:2006-06-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA134301261QA1903X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA309502OtherBLACK LUNG PROGRAM PIN
PA391301OtherHEALTH ASSURANCE PIN
PA058074OtherFIRST PRIORITY HEALTH PIN
PA391301OtherBLUE CROSS PIN
PA20020966OtherAMERIHEALTH HMO AMER PIN
PA29430OtherGEISINGER HEALTH PLAN PIN
PA000111OtherAMERIHEALTH ADMINISTR PIN
PA1004905OtherKEYSTONE MERCY HEALTH PIN
PA1007607800008Medicaid
PA391301OtherAETNA PIN
PA391301OtherHEALTH AMERICA PIN
PA391301OtherHEALTH AMERICA PIN
PA391301OtherHEALTH AMERICA PIN