Basic Information
| Provider Information | |||||||||
| NPI: | 1992439889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSAL COMPLETE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8310 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240140310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
| FaxNumber: | 5403422193 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 ROANOKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241536408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407693964 | ||||||||
| FaxNumber: | 5403182500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROCHERO | ||||||||
| AuthorizedOfficialFirstName: | ALFONSO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESDIENT | ||||||||
| AuthorizedOfficialTelephone: | 5407693964 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.