Provider Demographics
NPI:1508105149
Name:THE UMA CENTER, LLC
Entity Type:Organization
Organization Name:THE UMA CENTER, LLC
Other - Org Name:UMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-596-2557
Mailing Address - Street 1:407 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2748
Mailing Address - Country:US
Mailing Address - Phone:208-596-2557
Mailing Address - Fax:
Practice Address - Street 1:414 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2937
Practice Address - Country:US
Practice Address - Phone:208-596-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing