MEDICARE: UVPC SPECIALISTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013017078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UVPC SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 425
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-0425
Country	:	US
Telephone Number	:	937-773-0428
Fax Number	:	937-773-0439

Provider Business Practice Location Address
First Line	:	450 N HYATT ST
Second Line	:	SUITE 206
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1433
Country	:	US
Telephone Number	:	937-773-0428
Fax Number	:	937-773-0439

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PAMELA RADER
Credential	:
Telephone Number	:	937-440-7454

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/20/2010

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Directions to “UVPC SPECIALISTS, INC. ” Practice Location

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