Urban Community Physician Advisory Board LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

MD080525L Issued in PA

Legal business name

URBAN COMMUNITY PHYSICIAN ADVISORY BOARD LLC

Practice address

722 Church LN
Yeadon, PA 19050-3503

Phone

(610) 622-9953

Fax

(610) 284-6540

NPI assigned

Feb 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael W Milbourne, MD

Title

President

Phone

(215) 966-1546

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1003206608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 CHURCH LN",
            "city": "YEADON",
            "state": "PA",
            "postal_code": "190503503",
            "telephone_number": "610-622-9953",
            "fax_number": "610-284-6540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 CHURCH LN",
            "city": "YEADON",
            "state": "PA",
            "postal_code": "190503503",
            "telephone_number": "610-622-9953",
            "fax_number": "610-284-6540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN COMMUNITY PHYSICIAN ADVISORY BOARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MILBOURNE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-966-1546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "PA",
            "license": "MD080525L",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10397151001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Yeadon, PA
• Providers in Yeadon, PA by specialty
• Multi-Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.