Provider Demographics
NPI:1467842443
Name:UNIVERSAL SCREEN, INC
Entity Type:Organization
Organization Name:UNIVERSAL SCREEN, INC
Other - Org Name:UNIVERSAL SCREEN, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:GALLAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-489-0045
Mailing Address - Street 1:2516 HOSPITALITY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-0216
Mailing Address - Country:US
Mailing Address - Phone:931-489-0045
Mailing Address - Fax:931-489-0087
Practice Address - Street 1:2516 HOSPITALITY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-0216
Practice Address - Country:US
Practice Address - Phone:931-489-0045
Practice Address - Fax:931-489-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0081059171W00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019909Medicaid