Provider Demographics
NPI:1720351315
Name:UMS WEST FLORIDA LITHOTRIPSY LP
Entity Type:Organization
Organization Name:UMS WEST FLORIDA LITHOTRIPSY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-870-6565
Mailing Address - Street 1:1500 W PARK DR STE 390
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3934
Mailing Address - Country:US
Mailing Address - Phone:508-870-6565
Mailing Address - Fax:508-870-1563
Practice Address - Street 1:1500 W PARK DR STE 390
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3934
Practice Address - Country:US
Practice Address - Phone:508-870-6565
Practice Address - Fax:508-870-1563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UMS LITHOTRIPSY MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy