MEDICARE: UNIVERSITY HOSPITALS CASE 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	282NC2000X	Children's Hospital	COA.08599-NP	OH

General Provider Information

NPI Number	:	1851662175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS CASE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	11100 EUCLID AVE # 3001
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-3267
Fax Number	:	216-844-1841

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE # 3001
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-3267
Fax Number	:	216-844-1841

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	COLETTE BUCUR
Credential	:	CNP
Telephone Number	:	216-844-1902

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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