Provider Demographics
NPI:1902201056
Name:UNIVERSITY PRIMARY CARE PRACTICES, INC
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES, INC
Other - Org Name:UHMP SARIDAKIS AND LOYKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-692-1144
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:216-743-8130
Mailing Address - Fax:216-743-8131
Practice Address - Street 1:303 E ROYALTON RD
Practice Address - Street 2:STE 202
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44147-2591
Practice Address - Country:US
Practice Address - Phone:216-743-8130
Practice Address - Fax:216-743-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty