Basic Information
| Provider Information | |||||||||
| NPI: | 1073518213 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UPMC SOMERSET | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SOMERSET HOSP COMM SNF | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 225 S CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144435040 | ||||||||
| FaxNumber: | 8144435697 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144435040 | ||||||||
| FaxNumber: | 8144435697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RUSH | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8144435000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 193202 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.