Basic Information
| Provider Information | |||||||||
| NPI: | 1184366288 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY PRIMARY CARE PRACTICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY HOSPITALS MEDICAL PRACTICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26127 LORAIN RD STE 200B | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403292800 | ||||||||
| FaxNumber: | 4403292810 | ||||||||
| Practice Location | |||||||||
| Address1: | 26127 LORAIN RD STE 200B | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403292800 | ||||||||
| FaxNumber: | 4403292810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2022 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | JOI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISOR PE DEPT. | ||||||||
| AuthorizedOfficialTelephone: | 2168447775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY PRIMARY CARE PRACTICES, INC. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.