Provider Demographics
NPI:1124214630
Name:UNIVERSAL MEDICAL SERVICES INC
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISPIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEMAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-823-2947
Mailing Address - Street 1:1801 NICOLLET AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3745
Mailing Address - Country:US
Mailing Address - Phone:612-823-2947
Mailing Address - Fax:612-870-2947
Practice Address - Street 1:1801 NICOLLET AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3745
Practice Address - Country:US
Practice Address - Phone:612-823-2947
Practice Address - Fax:612-870-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No284300000XHospitalsSpecial HospitalGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5671767000(MHCP)Medicaid