Provider Demographics
NPI:1346606258
Name:UCMC 1960, LLC
Entity Type:Organization
Organization Name:UCMC 1960, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUDHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-785-1119
Mailing Address - Street 1:6930 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3702
Mailing Address - Country:US
Mailing Address - Phone:713-590-9747
Mailing Address - Fax:832-446-3956
Practice Address - Street 1:6930 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3702
Practice Address - Country:US
Practice Address - Phone:713-590-9747
Practice Address - Fax:832-446-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care