Provider Demographics
NPI:1689398455
Name:ULTIMA II, LLC
Entity Type:Organization
Organization Name:ULTIMA II, LLC
Other - Org Name:ULTIMAMEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:K.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-510-2100
Mailing Address - Street 1:2851 JESSUP RD UNIT 932
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-7545
Mailing Address - Country:US
Mailing Address - Phone:973-510-2100
Mailing Address - Fax:
Practice Address - Street 1:10320 LITTLE PATUXENT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3344
Practice Address - Country:US
Practice Address - Phone:973-510-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage