1982873683 NPI number — UNIVERSITY HOSPITALS MEDICAL PRACTICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982873683 NPI number — UNIVERSITY HOSPITALS MEDICAL PRACTICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HOSPITALS MEDICAL PRACTICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY PREMIER PEDIATRICIANS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982873683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44194-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-383-6776
Provider Business Mailing Address Fax Number:
216-383-6745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18599 LAKE SHORE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44119-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-383-7800
Provider Business Practice Location Address Fax Number:
216-383-5376
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIDDLE
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING SERVICES
Authorized Official Telephone Number:
216-383-6480

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2383853 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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