Provider Demographics
NPI:1992853923
Name:UPMC BEDFORD MEMORIAL
Entity Type:Organization
Organization Name:UPMC BEDFORD MEMORIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-623-1104
Mailing Address - Street 1:10455 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7046
Mailing Address - Country:US
Mailing Address - Phone:814-623-6161
Mailing Address - Fax:814-623-3535
Practice Address - Street 1:10455 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7046
Practice Address - Country:US
Practice Address - Phone:814-623-6161
Practice Address - Fax:814-623-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA650501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007460470026Medicaid
PA1007460470026Medicaid