Provider Demographics
NPI:1215257712
Name:UNIVERSITY HOSPITALS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:UNIVERSITY HOSPITALS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-383-6756
Mailing Address - Street 1:27401 EUCLID AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117
Mailing Address - Country:US
Mailing Address - Phone:216-383-6613
Mailing Address - Fax:216-201-4182
Practice Address - Street 1:960 CLAGUE RD
Practice Address - Street 2:SUITE 2300
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1582
Practice Address - Country:US
Practice Address - Phone:216-383-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691903Medicaid
OHUN9364361Medicare PIN