Provider Demographics
NPI:1144402876
Name:UNIVERSITY FAMILY HEALTHCARE PA
Entity type:Organization
Organization Name:UNIVERSITY FAMILY HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-351-2020
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2894
Mailing Address - Country:US
Mailing Address - Phone:941-351-2020
Mailing Address - Fax:941-360-1362
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2894
Practice Address - Country:US
Practice Address - Phone:941-351-2020
Practice Address - Fax:941-360-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2398261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258501400Medicaid
FL258501400Medicaid