MEDICARE: UNIVERSITY PRIMARY CARE PRACTICES

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1912127150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PRIMARY CARE PRACTICES

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-646-9636
Fax Number	:	440-646-3816

Provider Business Practice Location Address
First Line	:	5885 LANDERBROOK DR STE 150
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4031
Country	:	US
Telephone Number	:	440-646-9636
Fax Number	:	440-646-3816

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	STEVE RIDDLE
Credential	:
Telephone Number	:	216-383-6480

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	03/17/2011

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