Healthcare Provider Details

I. General information

NPI: 1215989447
Provider Name (Legal Business Name): UNIVERSITY SUBURBAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 SOUTH GREEN ROAD SUITE 016
SOUTH EUCLID OH
44121-4129
US

IV. Provider business mailing address

1611 SOUTH GREEN ROAD SUITE 009
SOUTH EUCLID OH
44121-4129
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-8920
  • Fax: 216-382-1684
Mailing address:
  • Phone: 216-382-8920
  • Fax: 216-382-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES R ABBEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-297-2032