Provider Demographics
NPI:1912127150
Name:UNIVERSITY PRIMARY CARE PRACTICES
Entity Type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES
Other - Org Name:UNIVERSITY ORTHOPAEDIC SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BILLING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDLE
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:440-646-9636
Mailing Address - Fax:440-646-3816
Practice Address - Street 1:5885 LANDERBROOK DR STE 150
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4031
Practice Address - Country:US
Practice Address - Phone:440-646-9636
Practice Address - Fax:440-646-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4252080033Medicare NSC
OH9319237Medicare PIN