Healthcare Provider Details

I. General information

NPI: 1265780910
Provider Name (Legal Business Name): UC1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 LUMSDEN RD
BRANDON FL
33511
US

IV. Provider business mailing address

611 W AZEELE ST
TAMPA FL
33606-2205
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-1199
  • Fax: 813-464-2733
Mailing address:
  • Phone: 813-684-1199
  • Fax: 813-464-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES M LOWRANCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-684-1199