| University Medical Group, Inc | |
|
50 Maude St Providence RI 02908-4325 | |
| (401) 456-5368 | |
| Not Available |
| Full Name | University Medical Group, Inc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 50 Maude St, Providence, Rhode Island |
| Authorized Official Name and Position | Tracy Wallace (CEO) |
| Authorized Official Contact | 4014562717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Medical Group, Inc 825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2717 | University Medical Group, Inc 50 Maude St Providence RI 02908-4325 Ph: (401) 456-5368 |
| NPI Number | 1255367942 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255367942 | NPI | - | NPPES |
| UM 24173 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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