Healthcare Provider Details

I. General information

NPI: 1821340282
Provider Name (Legal Business Name): ULTIMATE CARE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 WINCHESTER AVE
ASHLAND KY
41101
US

IV. Provider business mailing address

3655 WINCHESTER AVE
ASHLAND KY
41101
US

V. Phone/Fax

Practice location:
  • Phone: 606-393-4632
  • Fax:
Mailing address:
  • Phone: 606-393-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number18D1102645
License Number StateKY

VIII. Authorized Official

Name: ROSE O URADU
Title or Position: LAB DIRECTOR
Credential: MD
Phone: 606-393-4632