Provider Demographics
NPI:1467667329
Name:UVPC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:UVPC SPECIALISTS, INC.
Other - Org Name:UPPER VALLEY ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
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:937-335-5806
Mailing Address - Fax:937-440-7219
Practice Address - Street 1:31 S STANFIELD RD
Practice Address - Street 2:SUITE 306
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2374
Practice Address - Country:US
Practice Address - Phone:937-335-5806
Practice Address - Fax:937-440-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2718509Medicaid
OH9359421Medicare PIN