Provider Demographics
NPI:1740365097
Name:UPMC WILLIAMSPORT
Entity type:Organization
Organization Name:UPMC WILLIAMSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-321-3175
Mailing Address - Street 1:600 GRANT STREET, US STEEL TOWER, 59TH FLOOR
Mailing Address - Street 2:C/O RENEE JOHNSON
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-2740
Mailing Address - Country:US
Mailing Address - Phone:412-623-6303
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-1000
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234601261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000109OtherAMERIHEALTH ADMINSTR PIN
PA1007548350019Medicaid
PA1007548350038Medicaid
PA074006OtherFIRST PRIORITY HEALTH PIN
PA1007548350034Medicaid
PA1007548350040Medicaid
PA301400OtherBLACK LUNG PROGRAM PIN
PA1017347OtherKEYSTONE MERCY HEALTH PIN
PA29796OtherGEISINGER HEALTH PLAN PIN
PA390045OtherHEALTH ASSURANCE PIN
PA390045OtherHEALTH AMERICA PIN
PA1007548350044Medicaid
PA390045OtherBLUE CROSS PIN
PA1007548350037Medicaid
PA1007548350041Medicaid
PA20007166OtherAMERIHEALTH HMO AMER PIN
PA390045OtherAETNA PIN
PA1007548350018Medicaid