Provider Demographics
NPI:1073833711
Name:UNIVERSAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL SERVICES, INC.
Other - Org Name:AXIS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:RONDESTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-990-6932
Mailing Address - Street 1:1801 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3791
Mailing Address - Country:US
Mailing Address - Phone:612-823-2947
Mailing Address - Fax:612-870-2947
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3791
Practice Address - Country:US
Practice Address - Phone:612-823-2947
Practice Address - Fax:612-870-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)