Provider Demographics
NPI:1629397294
Name:UNITED MEDICAL CLINIC OF PA, LLC
Entity Type:Organization
Organization Name:UNITED MEDICAL CLINIC OF PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEEMU
Authorized Official - Middle Name:VALERIE
Authorized Official - Last Name:KERKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-346-4543
Mailing Address - Street 1:5201 PENNELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6502
Mailing Address - Country:US
Mailing Address - Phone:877-346-4543
Mailing Address - Fax:866-713-7699
Practice Address - Street 1:5201 PENNELL RD STE A
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6502
Practice Address - Country:US
Practice Address - Phone:877-346-4543
Practice Address - Fax:866-713-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty