Healthcare Provider Details

I. General information

NPI: 1124214630
Provider Name (Legal Business Name): UNIVERSAL MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NICOLLET AVE S SUITE 101
MINNEAPOLIS MN
55403-3745
US

IV. Provider business mailing address

1801 NICOLLET AVE S SUITE 101
MINNEAPOLIS MN
55403-3745
US

V. Phone/Fax

Practice location:
  • Phone: 612-823-2947
  • Fax: 612-870-2947
Mailing address:
  • Phone: 612-823-2947
  • Fax: 612-870-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. CRISPIN J SEMAKULA
Title or Position: BOARD CHAIRMAN
Credential: M.D
Phone: 612-823-2947