Healthcare Provider Details

I. General information

NPI: 1407129737
Provider Name (Legal Business Name): UNIVERSAL MEDICAL ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 NATIONWIDE PKWY
BRUNSWICK OH
44212-2361
US

IV. Provider business mailing address

3065 NATIONWIDE PKWY
BRUNSWICK OH
44212-2361
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-5914
  • Fax: 440-243-6530
Mailing address:
  • Phone: 440-243-5914
  • Fax: 440-243-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. DAVID M GARNEK
Title or Position: SOLE MEMBER
Credential:
Phone: 440-243-5914