Provider Demographics
| NPI: | 1639158488 |
|---|---|
| Name: | UPMC ALTOONA REGIONAL HEALTH SERVICES, INC |
| Entity Type: | Organization |
| Organization Name: | UPMC ALTOONA REGIONAL HEALTH SERVICES, INC |
| Other - Org Name: | BLAIR MEDICAL ASSOCIATES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | BILLING MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JILL |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | SWAB |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CPCS |
| Authorized Official - Phone: | 814-949-7622 |
| Mailing Address - Street 1: | 1414 9TH AVE |
| Mailing Address - Street 2: | STATION MEDICAL CENTER |
| Mailing Address - City: | ALTOONA |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 16602-2454 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 814-946-1655 |
| Mailing Address - Fax: | 814-949-7616 |
| Practice Address - Street 1: | 1414 9TH AVE |
| Practice Address - Street 2: | STATION MEDICAL CENTER |
| Practice Address - City: | ALTOONA |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 16602-2454 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 814-946-1655 |
| Practice Address - Fax: | 814-949-7616 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-01-11 |
| Last Update Date: | 2015-10-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103T00000X, 133V00000X, 207N00000X, 207R00000X, 207RE0101X, 207RH0003X, 207RP1001X, 2084N0400X, 2085R0202X, 213E00000X | ||
| PA | MD439371 | 207RC0000X, 207RC0001X |
| PA | MD436098 | 207RI0011X |
| PA | MD428424 | 208200000X |
| PA | MD026570E | 208800000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 0719120001 | Other | DMERC |
| PA | 1015582 | Other | GATEWAY ENDO |
| PA | 000358443 | Other | HIGHMARK PSYCHOLOGY |
| PA | 1007393100018 | Medicaid | |
| PA | 00148787610002 | Medicaid | |
| PA | 1007393100022 | Medicaid | |
| PA | 028905 | Other | HIGHMARK GROUP NUMBER |
| PA | 1007393100001 | Medicaid | |
| PA | 1014409 | Other | GATEWAY NEUROLOGY |
| PA | 1015438 | Other | GATEWAY SURGERY |
| PA | 1015584 | Other | GATEWAY DERM |
| PA | 1015429 | Other | GATEWAY PODIATRY |
| PA | 117185 | Other | HIGHMARK PODIATRY |
| PA | 1007393100101 | Medicaid | |
| PA | 1556762 | Other | GATEWAY OB-GYN |
| PA | 1007393100018 | Medicaid |
