=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467533885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY PRIMARY CARE PRACTICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 02/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26127 LORAIN RD STE 100
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-743-8555
-----------------------------------------------------
Fax | 440-743-8556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24701 EUCLID AVE THIRD FLOOR - BILLING SERVICES
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44117-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-664-8150
-----------------------------------------------------
Fax | 330-664-8151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF UH PHYSICIAN SERVICES
-----------------------------------------------------
Name | DR. CLIFF A MEGERIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 216-844-5500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------