Provider Demographics
NPI:1316184757
Name:UVPC SPECIALISTS INC.
Entity Type:Organization
Organization Name:UVPC SPECIALISTS INC.
Other - Org Name:TROY CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-440-7454
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0425
Mailing Address - Country:US
Mailing Address - Phone:937-332-1165
Mailing Address - Fax:937-332-1384
Practice Address - Street 1:998 S DORSET RD
Practice Address - Street 2:SUITE 204
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4753
Practice Address - Country:US
Practice Address - Phone:937-332-1165
Practice Address - Fax:937-332-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2718509Medicaid
OH2718509Medicaid