Provider Demographics
NPI:1265780910
Name:UC1, LLC
Entity type:Organization
Organization Name:UC1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-684-1199
Mailing Address - Street 1:611 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2205
Mailing Address - Country:US
Mailing Address - Phone:813-684-1199
Mailing Address - Fax:813-464-2733
Practice Address - Street 1:799 LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-684-1199
Practice Address - Fax:813-464-2733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UC ADMIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006639500Medicaid