Healthcare Provider Details

I. General information

NPI: 1689900904
Provider Name (Legal Business Name): UNIVERSITY HOSPITAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 MENTOR AVE
MENTOR OH
44060-4496
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD 1ST FLOOR
SHAKER HTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1000
  • Fax:
Mailing address:
  • Phone: 216-286-6260
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: LARRY MCELROY
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 216-767-8717