Provider Demographics
NPI:1407885338
Name:UNIVERSITY FAMILY MEDICINE ASSOCIATION
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY MEDICINE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-844-2638
Mailing Address - Street 1:5910 LANDERBROOK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6508
Mailing Address - Country:US
Mailing Address - Phone:216-844-3944
Mailing Address - Fax:440-449-1555
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3944
Practice Address - Fax:440-449-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792156Medicaid
OH=========01OtherBWC
OH0792156Medicaid