Provider Demographics
NPI:1275312530
Name:UNITED FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:UNITED FAMILY MEDICAL CENTER LLC
Other - Org Name:UNITED FAMILY MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETORSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRUBAKRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-255-2612
Mailing Address - Street 1:1 WALLACE BASHAW WAY STE 1002
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3876
Mailing Address - Country:US
Mailing Address - Phone:978-255-2612
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY STE 1002
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3876
Practice Address - Country:US
Practice Address - Phone:978-808-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care