Provider Demographics
NPI:1780940973
Name:MCRICHLANDS PLLC
Entity type:Organization
Organization Name:MCRICHLANDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UZOMA
Authorized Official - Middle Name:KELECHI
Authorized Official - Last Name:NWAUBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-633-0703
Mailing Address - Street 1:9580 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785
Mailing Address - Country:US
Mailing Address - Phone:352-633-0703
Mailing Address - Fax:352-399-2168
Practice Address - Street 1:9580 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-1762
Practice Address - Country:US
Practice Address - Phone:352-633-0703
Practice Address - Fax:352-399-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105721207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149R7OtherBCBS
FL002182700Medicaid
FLGJ186AMedicaid
FL002182700Medicaid