Provider Demographics
NPI: | 1669499414 |
---|---|
Name: | UNIVERSITY HOSPITALS MEDICAL GROUP, INC |
Entity Type: | Organization |
Organization Name: | UNIVERSITY HOSPITALS MEDICAL GROUP, INC |
Other - Org Name: | UHMG INC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PRESIDENT, UH PHYSICIAN SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CLIFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MEGERIAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 216-844-5500 |
Mailing Address - Street 1: | PO BOX 772928 |
Mailing Address - Street 2: | |
Mailing Address - City: | DETROIT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48277-2937 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-589-6006 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11100 EUCLID AVE |
Practice Address - Street 2: | |
Practice Address - City: | CLEVELAND |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44106-1716 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-844-1000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UNIVERSITY HOSPITALS HEALTH SYSTEM, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-07-17 |
Last Update Date: | 2023-08-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | 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 | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | 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 |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | DF2958 | Other | RAILROAD MEDICARE |
OH | 2691903 | Medicaid | |
OH | UN9364361 | Medicare PIN | |
OH | DF2958 | Other | RAILROAD MEDICARE |