1073724324 NPI number — UNIVERSITY PRIMARY CARE 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 1073724324 NPI number — UNIVERSITY PRIMARY CARE PRACTICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PRIMARY CARE 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 SOUTHWEST SURGEONS
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:
1073724324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-8792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-816-5500
Provider Business Mailing Address Fax Number:
440-816-5514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7215 OLD OAK BLVD STE A311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-816-5500
Provider Business Practice Location Address Fax Number:
440-816-5514
Provider Enumeration Date:
05/25/2007

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 BILLINS SERVICES
Authorized Official Telephone Number:
216-383-6480

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , 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)





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