Healthcare Provider Details

I. General information

NPI: 1417011941
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CLAGUE RD SUITE 2460
WESTLAKE OH
44145-1582
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD 1ST FLOOR, MSC9152
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1000
  • Fax: 216-286-6299
Mailing address:
  • Phone: 216-286-6296
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LARRY D MCELROY
Title or Position: V.P. FINANCE
Credential:
Phone: 216-983-3175