1467896472 NPI number — UNIVERSAL LIFE SERVICES LLC

Table of content: (NPI 1467896472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467896472 NPI number — UNIVERSAL LIFE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL LIFE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467896472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4609 W BROAD ST
Provider Second Line Business Mailing Address:
SUITE A2
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-218-8959
Provider Business Mailing Address Fax Number:
804-355-5420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4609 W BROAD ST
Provider Second Line Business Practice Location Address:
SUITE A2
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-218-8959
Provider Business Practice Location Address Fax Number:
804-355-5420
Provider Enumeration Date:
04/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
CALVIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
804-281-8959

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)