Provider Demographics
NPI:1821124975
Name:UPMC COMMUNITY MEDICINE INC
Entity Type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:SOUTHWEST FAMILY PRACTICE UPMC
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 1:1275 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5385
Mailing Address - Country:US
Mailing Address - Phone:724-838-0870
Mailing Address - Fax:
Practice Address - Street 1:1275 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5385
Practice Address - Country:US
Practice Address - Phone:724-838-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare ID - Type Unspecified