Provider Demographics
NPI:1578706438
Name:UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION
Other - Org Name:CIDEM UIVERSITY HOSPITALS LABORATORY
Other - Org Type:Doing Business As
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:216-844-5678
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:PATH 5077
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0667996291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0915926Medicaid
OH0195926Medicaid
OH0195926Medicaid
OHD368943Medicare PIN
OHD368944Medicare PIN
OHD369341Medicare PIN
OH0915926Medicaid
OHD368942Medicare PIN
OHD368941Medicare PIN
OHD368931Medicare PIN