MEDICARE: THE UMA CENTER, LLC

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	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1508105149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UMA CENTER, LLC

Provider Business Mailing Address
First Line	:	407 N POLK ST
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-2748
Country	:	US
Telephone Number	:	208-596-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 S JEFFERSON ST
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-2937
Country	:	US
Telephone Number	:	208-596-2557
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	NICOLE WERNER
Credential	:	PHD
Telephone Number	:	208-596-2557

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	02/01/2013

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Directions to “THE UMA CENTER, LLC ” Practice Location

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