Healthcare Provider Details

I. General information

NPI: 1821290842
Provider Name (Legal Business Name): UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26250 EUCLID AVE STE 201
EUCLID OH
44132-3691
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 216-289-2221
  • Fax: 216-289-7285
Mailing address:
  • Phone: 216-289-2221
  • Fax: 216-289-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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