Provider Demographics
NPI:1841264868
Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FP&A
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-767-8141
Mailing Address - Street 1:PO BOX 772930
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2930
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-835-8000
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0452670002OtherCARESOURCE
OH0452675Medicaid
10602OtherQUALCHOICE
312882OtherBLACK LUNG
OH34189345200OtherBUREAU OF WORKERS COMPENS
00606903OtherAETNA US HEALTHCARE
OH341893452011OtherMEDICAL MUTUAL OF OHIO CD
5000129OtherUNITED HEALTHCARE
204898000OtherMAGELLAN BEHAVIORAL HLTH
OH341893452010OtherMEDICAL MUTUAL OF OHIO
000000227443OtherANTHEM
0452675OtherPEOPLES HEALTH PLAN
10602OtherQUALCHOICE