Provider Demographics
NPI:1205865987
Name:UNIVERSAL MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL ASSOCIATES, PLLC
Other - Org Name:UNIVERSAL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-893-4111
Mailing Address - Street 1:100 S 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6690
Mailing Address - Country:US
Mailing Address - Phone:910-893-4111
Mailing Address - Fax:910-893-9850
Practice Address - Street 1:3396 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7233
Practice Address - Country:US
Practice Address - Phone:919-781-8897
Practice Address - Fax:919-782-4983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL MEDICAL ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016NVMedicaid
NC89016NVMedicaid
NC89014K1Medicaid