Provider Demographics
NPI:1174969703
Name:UNIVERSITY CENTER MEDICAL LLC
Entity type:Organization
Organization Name:UNIVERSITY CENTER MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-726-1600
Mailing Address - Street 1:1800 W HIBISCUS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2624
Mailing Address - Country:US
Mailing Address - Phone:321-726-1600
Mailing Address - Fax:321-726-1610
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2624
Practice Address - Country:US
Practice Address - Phone:321-726-1600
Practice Address - Fax:321-726-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care