Provider Demographics
NPI:1407129737
Name:UNIVERSAL MEDICAL ANCILLARY SERVICES
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL ANCILLARY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARNEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-243-5914
Mailing Address - Street 1:3065 NATIONWIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2361
Mailing Address - Country:US
Mailing Address - Phone:440-243-5914
Mailing Address - Fax:440-243-6530
Practice Address - Street 1:3065 NATIONWIDE PKWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2361
Practice Address - Country:US
Practice Address - Phone:440-243-5914
Practice Address - Fax:440-243-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty