Basic Information
| Provider Information | |||||||||
| NPI: | 1871570614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPMC CHAUTAUQUA AT WCA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOMAN'S CHRISTIAN ASSOCIATION HOSPITAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRANT STREET, US STEEL TOWER, 59TH FLOOR | ||||||||
| Address2: | C/O RENEE JOHNSON | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152192740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126236303 | ||||||||
| FaxNumber: | 4126236369 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 FOOTE AVE | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147017077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164870141 | ||||||||
| FaxNumber: | 7164871802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DINGER | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8148773739 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UPMC CHAUTAUQUA AT WCA | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 0602001H | NY | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 03001769 | 05 | NY | MEDICAID |