Provider Demographics
NPI:1942294467
Name:UB FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:UB FAMILY MEDICINE, INC
Other - Org Name:UBMD PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/PLAN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-816-7228
Mailing Address - Street 1:77 GOODELL STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-645-9694
Mailing Address - Fax:716-845-6699
Practice Address - Street 1:77 GOODELL STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1243
Practice Address - Country:US
Practice Address - Phone:716-645-9694
Practice Address - Fax:716-845-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01739220Medicaid
14205AMedicare ID - Type Unspecified