Provider Demographics
NPI:1497884605
Name:UNIVERSITY PRIMARY CARE PRACTICES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES, INC.
Other - Org Name:UH STATE ROAD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MED STAFF SERVICES & CRED
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-844-2045
Mailing Address - Street 1:PO BOX 772040
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2040
Mailing Address - Country:US
Mailing Address - Phone:216-383-6480
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:805 E WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3331
Practice Address - Country:US
Practice Address - Phone:330-721-8474
Practice Address - Fax:216-201-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty