Provider Demographics
NPI:1336277953
Name:UPMC JAMESON
Entity Type:Organization
Organization Name:UPMC JAMESON
Other - Org Name:UPMC JAMESON PARTIAL PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-656-4107
Mailing Address - Street 1:PO BOX 382007
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-8007
Mailing Address - Country:US
Mailing Address - Phone:724-656-4008
Mailing Address - Fax:724-656-4171
Practice Address - Street 1:253 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3618
Practice Address - Country:US
Practice Address - Phone:724-656-4100
Practice Address - Fax:724-656-4171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC JAMESON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA941450261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021890028Medicaid
PA390016Medicare Oscar/Certification