1588528798 NPI number — UNIVERSAL CONNECTION HEALTHCARE AGENCY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588528798 NPI number — UNIVERSAL CONNECTION HEALTHCARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL CONNECTION HEALTHCARE AGENCY
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:
1588528798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14415 BRISTOL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANDVIEW
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64030-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-585-7657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14415 BRISTOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64030-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-585-7657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2025

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
TRISEANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHLEBOTOMIST
Authorized Official Telephone Number:
816-585-7657

Provider Taxonomy Codes

  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 202K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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