Provider Demographics
NPI:1336368588
Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-383-6480
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:440-964-3733
Mailing Address - Fax:440-964-7069
Practice Address - Street 1:1184 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2930
Practice Address - Country:US
Practice Address - Phone:440-964-3733
Practice Address - Fax:440-964-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty