Provider Demographics
NPI:1639206410
Name:UPMC WESTERN MARYLAND CORPORATION
Entity Type:Organization
Organization Name:UPMC WESTERN MARYLAND CORPORATION
Other - Org Name:FBMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP. CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-964-8032
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-0539
Mailing Address - Country:US
Mailing Address - Phone:240-964-8343
Mailing Address - Fax:240-964-8338
Practice Address - Street 1:10701 NEW GEORGES CREEK RD SW
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1457
Practice Address - Country:US
Practice Address - Phone:301-689-3229
Practice Address - Fax:301-723-1480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC WESTERN MARYLAND CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62018801 KFA5SAOtherCAREFIRST - X-RAY
MDW474SA 61636304OtherCAREFIRST - LAB
DCH857 0001OtherBLUE CHOICE