MEDICARE: UNIVERSITY SUBURBAN HEALTH 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	261QA1903X	Ambulatory Surgical Clinic/Center

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	:	1528010360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY SUBURBAN HEALTH CENTER

Provider Business Mailing Address
First Line	:	1611 SOUTH GREEN ROAD
Second Line	:	SUITE 009
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4129
Country	:	US
Telephone Number	:	216-382-8920
Fax Number	:	216-382-1684

Provider Business Practice Location Address
First Line	:	1611 SOUTH GREEN ROAD
Second Line	:	SUITE 124
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4129
Country	:	US
Telephone Number	:	216-382-8920
Fax Number	:	216-382-1684

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHARLES R ABBEY
Credential	:
Telephone Number	:	216-297-2032

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	09/14/2011

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Directions to “UNIVERSITY SUBURBAN HEALTH CENTER ” Practice Location

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