MEDICARE: UNIVERSITY HOSPITALS URGENT CARE, LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1942928288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 772040
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 SNOW RD STE 200
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2860
Country	:	US
Telephone Number	:	216-265-0772
Fax Number	:	216-201-4255

Authorized Official
Title or Position	:	DIRECTOR, MSS, CREDENTIALING, PE
Name	:	JANNA M KENNEDY
Credential	:
Telephone Number	:	216-844-2045

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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