Provider Demographics
NPI:1811174469
Name:UPTOWN MEDICAL
Entity type:Organization
Organization Name:UPTOWN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-733-2612
Mailing Address - Street 1:450 DISTRIBUTION DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1176
Mailing Address - Country:US
Mailing Address - Phone:321-733-2612
Mailing Address - Fax:
Practice Address - Street 1:450 DISTRIBUTION DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1176
Practice Address - Country:US
Practice Address - Phone:321-733-2612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies