Provider Demographics
NPI:1740859347
Name:UNIVERSITY CLINICIANS LLC
Entity type:Organization
Organization Name:UNIVERSITY CLINICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:P
Authorized Official - Last Name:JEAN-PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-470-7480
Mailing Address - Street 1:133 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5710
Mailing Address - Country:US
Mailing Address - Phone:920-470-7480
Mailing Address - Fax:920-903-1452
Practice Address - Street 1:133 E COLLEGE AVE STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5710
Practice Address - Country:US
Practice Address - Phone:920-470-7480
Practice Address - Fax:920-903-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center