Provider Demographics
NPI:1306905815
Name:UAS MANAGEMENT, INC.
Entity type:Organization
Organization Name:UAS MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-580-3400
Mailing Address - Street 1:1390 E YOSEMITE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8221
Mailing Address - Country:US
Mailing Address - Phone:209-580-3400
Mailing Address - Fax:
Practice Address - Street 1:1390 E YOSEMITE AVE STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-580-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000537261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS1571OtherBLUE CROSS
CA353163400OtherUS DEPT OF LABOR
CAZZZH2404ZOtherBLUE SHIELD
CASUR01571FMedicaid
CASUR01571FMedicaid