Provider Demographics
NPI:1194515536
Name:UC MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:UC MEDICAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-835-7944
Mailing Address - Street 1:PO BOX 250267
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9613 COIT RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7378
Practice Address - Country:US
Practice Address - Phone:617-835-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care