Provider Demographics
NPI:1346795754
Name:BRUCE H ULLERUP
Entity Type:Organization
Organization Name:BRUCE H ULLERUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:828-515-5120
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-1030
Mailing Address - Country:US
Mailing Address - Phone:828-777-3755
Mailing Address - Fax:828-225-2531
Practice Address - Street 1:70 WOODFIN PL
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2463
Practice Address - Country:US
Practice Address - Phone:828-777-3755
Practice Address - Fax:828-225-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003071251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health