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NPI Code Detail

MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology PhysicianOH
2208000000XPediatrics PhysicianOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902039050
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 3605 WARRENSVILLE CENTER RD
Second Line : 1ST FLOOR
City : SHAKER HTS
State : OH
Zip : 44122-5203
Country : US
Telephone Number : 216-286-6260
Fax Number : 216-286-6341
Provider Business Practice Location Address
First Line : 9772 DIAGONAL RD
Second Line :
City : MANTUA
State : OH
Zip : 44255-9128
Country : US
Telephone Number : 330-274-2272
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT OF FINANCE
Name : LARRY MCELROY
Credential :
Telephone Number : 216-767-8717
Provider Enumeration Date : 08/24/2009
Last Update Date : 08/24/2009

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