Provider Demographics
NPI:1003527821
Name:UCM DIGITAL IPA, INC.
Entity Type:Organization
Organization Name:UCM DIGITAL IPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBIGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-484-7362
Mailing Address - Street 1:216 RIVER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 RIVER ST STE 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3848
Practice Address - Country:US
Practice Address - Phone:844-484-7362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCM DIGITAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty