Provider Demographics
NPI:1063456408
Name:UDS, INC
Entity Type:Organization
Organization Name:UDS, INC
Other - Org Name:UNIVERSAL DESIGN SOLUTIONS PDG MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:PESSOLANO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:904-721-2225
Mailing Address - Street 1:2375 ST JOHNS BLUFF RD S
Mailing Address - Street 2:STE 306
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246
Mailing Address - Country:US
Mailing Address - Phone:904-721-2225
Mailing Address - Fax:877-430-2291
Practice Address - Street 1:2375 ST JOHNS BLUFF RD S
Practice Address - Street 2:# 306
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-721-2225
Practice Address - Fax:877-430-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1729332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025903900Medicaid
FL330998744OtherTAX ID #
FL684821400OtherAAA WAIVER ID#
FL685292196OtherDS WAIVER ID
FLR9263OtherBCBS PROVIDER #
FL685292196OtherDS WAIVER ID