Provider Demographics
NPI:1295865087
Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Other - Org Name:INTERNAL MEDICINE ASSOCIATES
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:330-725-3009
Mailing Address - Fax:330-722-7502
Practice Address - Street 1:4001 CARRICK DR STE 210
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5393
Practice Address - Country:US
Practice Address - Phone:330-725-3009
Practice Address - Fax:330-722-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307266Medicaid
OH2307266Medicaid