Provider Demographics
NPI:1164718961
Name:UCR MEDICAL, INC
Entity Type:Organization
Organization Name:UCR MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-869-0271
Mailing Address - Street 1:309 E RAY FINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5160
Mailing Address - Country:US
Mailing Address - Phone:918-503-6257
Mailing Address - Fax:918-503-6259
Practice Address - Street 1:309 E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5160
Practice Address - Country:US
Practice Address - Phone:918-503-6257
Practice Address - Fax:918-503-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain