MEDICARE: UNIVERSITY PRIMARY CARE PRACTICES 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1073634069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PRIMARY CARE PRACTICES INC

Provider Business Mailing Address
First Line	:	PO BOX 74588
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0002
Country	:	US
Telephone Number	:	216-383-6776
Fax Number	:	216-383-6745

Provider Business Practice Location Address
First Line	:	960 CLAGUE RD STE 1100A
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1590
Country	:	US
Telephone Number	:	216-383-0100
Fax Number	:	216-383-6745

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	04/09/2010

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