Provider Demographics
NPI:1609920206
Name:UPMC JAMESON
Entity Type:Organization
Organization Name:UPMC JAMESON
Other - Org Name:UPMC JAMESON SHORT PROCEDURE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-748-6805
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 1:1211 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2516
Practice Address - Country:US
Practice Address - Phone:724-658-9001
Practice Address - Fax:724-656-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC JAMESON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021890020Medicaid
PA1000021890020Medicaid