1730404831 NPI number — UNIVERSITY HOSPITALS MEDICAL GROUP, INC

Table of content: (NPI 1730404831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730404831 NPI number — UNIVERSITY HOSPITALS MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HOSPITALS MEDICAL GROUP, 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:
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:
1730404831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3605 WARRENSVILLE CENTER RD
Provider Second Line Business Mailing Address:
SUITE 1342
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-286-6296
Provider Business Mailing Address Fax Number:
216-286-6341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 CLAGUE RD
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 104
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-286-6296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCELROY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
216-383-6765

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , 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: 2691903 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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