Provider Demographics
NPI:1619004470
Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Other - Org Name:UH QCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR BUSINESS OPERATIONS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-358-2348
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:216-383-6776
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:350 HILLCREST DR
Practice Address - Street 2:STE 3
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4052
Practice Address - Country:US
Practice Address - Phone:419-207-2502
Practice Address - Fax:419-207-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4252080040Medicare NSC
OH9379335Medicare PIN