Provider Demographics
NPI:1538179163
Name:UPMC-BRADDOCK
Entity type:Organization
Organization Name:UPMC-BRADDOCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEVCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-636-5100
Mailing Address - Street 1:400 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1599
Mailing Address - Country:US
Mailing Address - Phone:412-636-5100
Mailing Address - Fax:412-636-5398
Practice Address - Street 1:400 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1599
Practice Address - Country:US
Practice Address - Phone:412-636-5100
Practice Address - Fax:412-636-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #