Provider Demographics
NPI: | 1548592843 |
---|---|
Name: | UNIVERSITY HOSPITALS MEDICAL GROUP, INC. |
Entity Type: | Organization |
Organization Name: | UNIVERSITY HOSPITALS MEDICAL GROUP, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT OF FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LARRY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCELROY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-767-8717 |
Mailing Address - Street 1: | 3605 WARRENSVILLE CENTER RD |
Mailing Address - Street 2: | 1ST FLOOR |
Mailing Address - City: | SHAKER HTS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44122-5203 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 216-286-6260 |
Mailing Address - Fax: | 216-286-6341 |
Practice Address - Street 1: | 27100 CHARDON RD |
Practice Address - Street 2: | |
Practice Address - City: | RICHMOND HTS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44143-1116 |
Practice Address - Country: | US |
Practice Address - Phone: | 440-585-6500 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-02-11 |
Last Update Date: | 2010-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 207L00000X, 207LP2900X, 207N00000X, 207RC0000X, 207T00000X, 207V00000X, 207W00000X, 207X00000X, 207Y00000X, 208200000X, 2084N0400X, 2085R0202X, 208600000X, 208800000X | |
207SG0201X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2691903 | Medicaid | |
OH | UN9364361 | Medicare PIN |