Provider Demographics
NPI:1871503441
Name:UPMC SOUTH SIDE
Entity Type:Organization
Organization Name:UPMC SOUTH SIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:412-488-5573
Mailing Address - Street 1:2000 MARY ST
Mailing Address - Street 2:ROESCH TAYLOR CTR. 4TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2054
Mailing Address - Country:US
Mailing Address - Phone:412-432-5500
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:QUANTUM #1 3RD FL.
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-432-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007727710006Medicaid
PA000000056466OtherMEDPLUS NUMBER
PA0969OtherHIGHMARK PROVIDER NUMBER
PA=========OtherCHAMPUS NUMBER
PA0969OtherHIGHMARK PROVIDER NUMBER