Provider Demographics
NPI:1114056124
Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Other - Org Name:UHMP - GEAUGA INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-383-6480
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-286-9588
Mailing Address - Fax:440-286-2837
Practice Address - Street 1:13170 RAVENNA RD STE 112
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7022
Practice Address - Country:US
Practice Address - Phone:440-286-9599
Practice Address - Fax:440-286-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9312408Medicare ID - Type UnspecifiedMCR GPR CHEST
OH9304431Medicare ID - Type UnspecifiedMCR GRP CHAG
OH9304432Medicare ID - Type UnspecifiedMCR GRP CHAR