Healthcare Provider Details

I. General information

NPI: 1184366288
Provider Name (Legal Business Name): UNIVERSITY PRIMARY CARE PRACTICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26127 LORAIN RD STE 200B
NORTH OLMSTED OH
44070-2741
US

IV. Provider business mailing address

PO BOX 772928
DETROIT MI
48277-2928
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-2800
  • Fax: 440-329-2810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DONALD DECARLO
Title or Position: CMO, EAST MARKET
Credential:
Phone: 440-285-2950