1013017078 NPI number — UVPC SPECIALISTS, INC.

Table of content: (NPI 1013017078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013017078 NPI number — UVPC SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UVPC SPECIALISTS, INC.
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:
6
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:
1013017078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45373-0425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-773-0428
Provider Business Mailing Address Fax Number:
937-773-0439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N HYATT ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
TIPP CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45371-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-773-0428
Provider Business Practice Location Address Fax Number:
937-773-0439
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RADER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
937-440-7454

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2718509 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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