Provider Demographics
NPI:1467427518
Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Other - Org Name:UH ST. JOHN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, FP&A
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-767-8141
Mailing Address - Street 1:PO BOX 772930
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2930
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-835-8000
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOHN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-22
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341893452013OtherMEDICAL MUTUAL OF OHIO
OH34189345207OtherBUREAU OF WORKERS COMPENS
000000157548OtherANTHEM
OH2137422Medicaid
OH341893452013OtherMEDICAL MUTUAL OF OHIO