1316077886 NPI number — UNIVERSITY PRIMARY CARE PRACTICES INC

Table of content: (NPI 1083142863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316077886 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:
Provider Other Organization Name Type Code:
6
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:
1316077886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 772040
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:
48277-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-461-6477
Provider Business Mailing Address Fax Number:
440-466-1871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 S GREEN RD
Provider Second Line Business Practice Location Address:
STE 063
Provider Business Practice Location Address City Name:
SOUTH EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44121-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-237-5012
Provider Business Practice Location Address Fax Number:
216-201-6673
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEGERIAN
Authorized Official First Name:
CLIFF
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT OF UH PHYSICIAN SERVICES
Authorized Official Telephone Number:
216-844-5500

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9379335 . This is a "MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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