Provider Demographics
NPI:1992179154
Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Other - Org Name:UH ST. JOHN MEDICAL CENTER
Other - Org Type:Other Name
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:440-827-5040
Mailing Address - Fax:440-827-5472
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5219
Practice Address - Country:US
Practice Address - Phone:440-827-5040
Practice Address - Fax:440-827-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336I0012X
OHRTP.022594600-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3009783Medicaid
2156051OtherPK