1053365221 NPI number — ULNACS MEDICAL CARE, PC

Table of content: (NPI 1053365221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053365221 NPI number — ULNACS MEDICAL CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULNACS MEDICAL CARE, PC
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:
1053365221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3331 TOLEDO TER STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20782-8156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-408-4111
Provider Business Mailing Address Fax Number:
301-408-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3331 TOLEDO TER STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20782-8156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-408-4111
Provider Business Practice Location Address Fax Number:
301-408-4600
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OKOJI
Authorized Official First Name:
GODSWILL
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-408-4111

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0050545 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 017125200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: G00880 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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