Provider Demographics
NPI:1992179493
Name:UNIVERSITY PRIMARY CARE PRACTICES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES, INC.
Other - Org Name:UH STREETSBORO URGENT CARE
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:330-626-3455
Mailing Address - Fax:330-626-4189
Practice Address - Street 1:9318 STATE ROUTE 14
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5224
Practice Address - Country:US
Practice Address - Phone:330-626-3455
Practice Address - Fax:330-626-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care