Provider Demographics
NPI:1669412201
Name:UNIVERSAL MEDICAL ADMINISTRATION
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-243-5914
Mailing Address - Street 1:7055 ENGLE ROAD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-243-5914
Mailing Address - Fax:440-243-6530
Practice Address - Street 1:7055 ENGLE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8491
Practice Address - Country:US
Practice Address - Phone:440-243-5914
Practice Address - Fax:440-243-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TC0700X
OH36-003029213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561151Medicaid
OHUN9353501Medicare ID - Type Unspecified
KY00514Medicare PIN