Provider Demographics
NPI:1215790852
Name:UNIVERSAL COMMUNITY HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:UNIVERSAL COMMUNITY HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:A MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-940-4611
Mailing Address - Street 1:706 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4917
Mailing Address - Country:US
Mailing Address - Phone:404-940-4611
Mailing Address - Fax:
Practice Address - Street 1:706 ADAMS ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4917
Practice Address - Country:US
Practice Address - Phone:404-940-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service