Provider Demographics
NPI:1417011941
Name:UNIVERSITY HOSPITALS MEDICAL GROUP
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITALS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-983-3175
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FLOOR, MSC9152
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6296
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:960 CLAGUE RD
Practice Address - Street 2:SUITE 2460
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1582
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:216-286-6299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HOSPITALS HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691903Medicaid
OHUN9364361Medicare PIN