Basic Information
| Provider Information | |||||||||
| NPI: | 1871732453 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HEALTH CLINICAL RESEARCH LIMITED LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4109 COVE CIR NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447086006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005270336 | ||||||||
| FaxNumber: | 3302448521 | ||||||||
| Practice Location | |||||||||
| Address1: | 4109 COVE CIR NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447086006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005270336 | ||||||||
| FaxNumber: | 3302448521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | WHITTIER | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8005270336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35053624W | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0632211 | 05 | OH | MEDICAID |