Healthcare Provider Details

I. General information

NPI: 1467842443
Provider Name (Legal Business Name): UNIVERSAL SCREEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 HOSPITALITY LN
COLUMBIA TN
38401-0216
US

IV. Provider business mailing address

2516 HOSPITALITY LN
COLUMBIA TN
38401-0216
US

V. Phone/Fax

Practice location:
  • Phone: 931-489-0045
  • Fax: 931-489-0087
Mailing address:
  • Phone: 931-489-0045
  • Fax: 931-489-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number0081059
License Number StateTN

VIII. Authorized Official

Name: LUCY WILLIAMS GALLAMORE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 931-489-0045