Provider Demographics
NPI:1639206402
Name:UPMC COMMUNITY MEDICINE INC
Entity Type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:UPMC BEDFORD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:118 S ANDERSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1403
Mailing Address - Country:US
Mailing Address - Phone:814-623-3474
Mailing Address - Fax:
Practice Address - Street 1:118 S ANDERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1403
Practice Address - Country:US
Practice Address - Phone:814-623-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042568OtherHIGHMARK MEDICARE GROUP
PA042568OtherHIGHMARK MEDICARE GROUP