Basic Information
| Provider Information | |||||||||
| NPI: | 1013030881 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY PRIMARY CARE PRACTICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TWINBURG FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8792 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252212 | ||||||||
| FaxNumber: | 3304252779 | ||||||||
| Practice Location | |||||||||
| Address1: | 8819 COMMONS BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | TWINSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440872177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252212 | ||||||||
| FaxNumber: | 3304252779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | LADER | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2163836480 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0181271 | 05 | OH | MEDICAID |