MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP,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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1750445227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP,INC

Provider Business Mailing Address
First Line	:	5910 LANDERBROOK DR
Second Line	:	SUITE 250
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-6508
Country	:	US
Telephone Number	:	440-684-5829
Fax Number	:	440-449-1555

Provider Business Practice Location Address
First Line	:	895 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	440-684-5829
Fax Number	:	440-449-1555

Authorized Official
Title or Position	:	VP FINANCE
Name	:	LARRY D MCELROY
Credential	:
Telephone Number	:	216-983-3175

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

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