Healthcare Provider Details

I. General information

NPI: 1982805917
Provider Name (Legal Business Name): UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 7TH AVE STE 110
CHARDON OH
44024-2909
US

IV. Provider business mailing address

PO BOX 74557
CLEVELAND OH
44194-0640
US

V. Phone/Fax

Practice location:
  • Phone: 440-286-8841
  • Fax: 440-286-8867
Mailing address:
  • Phone: 216-383-0100
  • Fax: 216-383-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. STEVE RIDDLE
Title or Position: DIRECTOR OF BILLING SERVICES
Credential:
Phone: 216-383-6480