Provider Demographics
NPI:1528010360
Name:UNIVERSITY SUBURBAN HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY SUBURBAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-297-2032
Mailing Address - Street 1:1611 SOUTH GREEN ROAD
Mailing Address - Street 2:SUITE 009
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4129
Mailing Address - Country:US
Mailing Address - Phone:216-382-8920
Mailing Address - Fax:216-382-1684
Practice Address - Street 1:1611 SOUTH GREEN ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4129
Practice Address - Country:US
Practice Address - Phone:216-382-8920
Practice Address - Fax:216-382-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0587217Medicaid
OH0587217Medicaid