Healthcare Provider Details

I. General information

NPI: 1548352859
Provider Name (Legal Business Name): UVPC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 LOONEY RD SUITE 204
PIQUA OH
45356-4199
US

IV. Provider business mailing address

PO BOX 425
TROY OH
45373-0425
US

V. Phone/Fax

Practice location:
  • Phone: 937-773-4123
  • Fax: 937-773-7717
Mailing address:
  • Phone: 937-773-4123
  • Fax: 937-773-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA RADER
Title or Position: ADMINISTRATOR
Credential:
Phone: 937-440-7454