Provider Demographics
NPI:1275814204
Name:UNIVERSAL BILLING GROUP
Entity Type:Organization
Organization Name:UNIVERSAL BILLING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYESHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-455-3500
Mailing Address - Street 1:6 SUSAN CIR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1014
Mailing Address - Country:US
Mailing Address - Phone:404-721-5000
Mailing Address - Fax:
Practice Address - Street 1:6 SUSAN CIR
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1014
Practice Address - Country:US
Practice Address - Phone:404-721-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000139246ZS0410X
VA887246ZS0410X
VA2795246ZS0410X
MDM560128792557363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1275814204OtherUNIVERSAL BILLING GROUP LLC
GA1992896880OtherRONALD JENNINGS
GA1649504903OtherPROVIDER
VA1568740439OtherPROVIDER
GA1396953873OtherPROVIDER