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	207P00000X	Emergency Medicine Physician		OH

General Provider Information

NPI Number	:	1619004470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PRIMARY CARE PRACTICES INC

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	216-383-6776
Fax Number	:	216-383-6745

Provider Business Practice Location Address
First Line	:	350 HILLCREST DR
Second Line	:	STE 3
City	:	ASHLAND
State	:	OH
Zip	:	44805-4052
Country	:	US
Telephone Number	:	419-207-2502
Fax Number	:	419-207-2394

Authorized Official
Title or Position	:	SR BUSINESS OPERATIONS ANALYST
Name	:	GABRIEL E LADER
Credential	:
Telephone Number	:	216-358-2348

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	01/30/2017

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