MEDICARE: UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER

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	261QU0200X	Urgent Care Clinic/Center		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104200146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 772930
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2930
Country	:	US
Telephone Number	:	440-466-1141
Fax Number	:	216-767-8778

Provider Business Practice Location Address
First Line	:	2131 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3466
Country	:	US
Telephone Number	:	440-992-0759
Fax Number	:	440-992-1334

Authorized Official
Title or Position	:	DIRECTOR, FP&A
Name	:	ANTHONY SCHILLERO
Credential	:
Telephone Number	:	216-767-8141

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	04/29/2024

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