Provider Demographics
NPI:1578001608
Name:USAC-3 LLC
Entity Type:Organization
Organization Name:USAC-3 LLC
Other - Org Name:USA CARE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-703-7997
Mailing Address - Street 1:174 SAUNDERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8945
Mailing Address - Country:US
Mailing Address - Phone:917-410-6933
Mailing Address - Fax:917-768-0799
Practice Address - Street 1:174 SAUNDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8945
Practice Address - Country:US
Practice Address - Phone:917-410-6933
Practice Address - Fax:917-768-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty