1063456408 NPI number — UDS, INC

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 1063456408 NPI number — UDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UDS, 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:
1063456408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2375 ST JOHNS BLUFF RD S
Provider Second Line Business Mailing Address:
STE 306
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-721-2225
Provider Business Mailing Address Fax Number:
877-430-2291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2375 ST JOHNS BLUFF RD S
Provider Second Line Business Practice Location Address:
# 306
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-721-2225
Provider Business Practice Location Address Fax Number:
877-430-2291
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PESSOLANO
Authorized Official First Name:
VINCE
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-721-2225

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1729 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025903900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330998744 . This is a "TAX ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 684821400 . This is a "AAA WAIVER ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 685292196 . This is a "DS WAIVER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R9263 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017293100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com