Provider Demographics
NPI:1518952365
Name:UCXTRA UMBRELLA, LLC
Entity Type:Organization
Organization Name:UCXTRA UMBRELLA, LLC
Other - Org Name:EAST VALLEY URGENT CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF OPERATIO
Authorized Official - Phone:480-988-9108
Mailing Address - Street 1:1635 N GREENFIELD RD
Mailing Address - Street 2:#126
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4005
Mailing Address - Country:US
Mailing Address - Phone:480-840-3075
Mailing Address - Fax:480-840-3025
Practice Address - Street 1:3200 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5107
Practice Address - Country:US
Practice Address - Phone:480-471-6404
Practice Address - Fax:480-219-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05178261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ412931Medicaid
AZZ83286Medicare PIN