1841264868 NPI number — UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841264868 NPI number — UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER

Employer Identification Number (EIN):

Provider Organization Name:

UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

UH ST. JOHN MEDICAL CENTER

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:

1841264868

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

10/19/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 772930

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DETROIT

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48277-2930

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

440-746-3401

Provider Business Mailing Address Fax Number:

440-746-3405

Provider First Line Business Practice Location Address:

29000 CENTER RIDGE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WESTLAKE

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44145-5293

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

440-835-8000

Provider Business Practice Location Address Fax Number:

440-746-3405

Provider Enumeration Date:

02/15/2006

Authorized Official Last Name:

SCHILLERO

Authorized Official First Name:

ANTHONY

Authorized Official Middle Name:

Authorized Official Title or Position:

DIRECTOR, FP&A

Authorized Official Telephone Number:

216-767-8141

• Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0452675 . This is a "PEOPLES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 5000129 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 204898000 . This is a "MAGELLAN BEHAVIORAL HLTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 341893452010 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0452675 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 312882 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
• Identifier: 00606903 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 10602 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 34189345200 . This is a "BUREAU OF WORKERS COMPENS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000227443 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 0452670002 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 341893452011 . This is a "MEDICAL MUTUAL OF OHIO CD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".