=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467615039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY MEDICAL ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 06/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 HOSPITAL DR SUITE 370
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-566-4530
-----------------------------------------------------
Fax | 740-566-4535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 PARKS HALL
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-593-2542
-----------------------------------------------------
Fax | 740-593-0626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. STEVE DAVIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-593-2267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number | 34003705
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------