MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP

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	152W00000X	Optometrist		OH
2	207W00000X	Ophthalmology Physician		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	:	1417187824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3606 WARRENSVILLE CTR RD
Second Line	:	MSC9152
City	:	SHAKER HTS
State	:	OH
Zip	:	44122
Country	:	US
Telephone Number	:	216-286-6299
Fax Number	:	216-286-6341

Provider Business Practice Location Address
First Line	:	895 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	216-844-3601
Fax Number	:	216-844-7117

Authorized Official
Title or Position	:	VP
Name	:	LARRY MCELROY
Credential	:
Telephone Number	:	216-767-8717

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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