MEDICARE: UNIVERSITY MEDNET INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1023021995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MEDNET INC.

Provider Business Mailing Address
First Line	:	PO BOX 74464
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0547
Country	:	US
Telephone Number	:	216-383-6480
Fax Number	:	216-383-6745

Provider Business Practice Location Address
First Line	:	9000 MENTOR AVE
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4496
Country	:	US
Telephone Number	:	216-383-0100
Fax Number	:	216-383-6481

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	MR. STEVE RIDDLE
Credential	:
Telephone Number	:	216-383-6480

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	06/24/2008

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