Healthcare Provider Details

I. General information

NPI: 1184753618
Provider Name (Legal Business Name): UNIVERSITY PRIMARY CARE PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 W MAIN ST
GENEVA OH
44041-1219
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 440-415-0280
  • Fax: 440-415-0252
Mailing address:
  • Phone: 440-415-0280
  • Fax: 440-415-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

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