Provider Demographics
NPI:1821007881
Name:UPMC PRESBYTERIAN SHADYSIDE
Entity type:Organization
Organization Name:UPMC PRESBYTERIAN SHADYSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-864-7000
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:412-623-6369
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:
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:2006-08-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101249Medicaid
PA1000019040029Medicaid
OH7061889Medicaid
WV0001672000Medicaid
PA0013OtherHIGHMARK PROVIDER NUMBER
PA29OtherUPMC HEALTH PLAN NUMBER
PA0009609OtherPUH AENTA HMO NUMBER
PA390164OtherHEALTHAMERICA NUMBER
PA7066379OtherUNITED HEALTHCARE NUMBER
PA0006491150OtherAETNA US HEALTHCARE NUMBE
NY00814902OtherPUH NY MEDICAID NUMBER
PA1001064OtherSHY GATEWAY NUMBER
PA1001449OtherGATEWAY NUMBER
PA000000140485OtherMEDPLUS NUMBER
PA0012010OtherSHY AENTA HMO NUMBER
NY00814902Medicaid
WV0101249Medicaid
PA1000019040029Medicaid
WV0101249Medicaid
NY00814902Medicaid