Provider Demographics
NPI:1235252347
Name:UNIVERSITY PRIMARY CARE PHYSICIANS
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PHYSICIANS
Other - Org Name:UHMP - VASULAR SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-383-6480
Mailing Address - Street 1:PO BOX 74913
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0996
Mailing Address - Country:US
Mailing Address - Phone:216-383-6480
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:VASCULAR LAB
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:216-383-0100
Practice Address - Fax:216-383-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9326367Medicare ID - Type Unspecified