Provider Demographics
NPI:1902996119
Name:UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER
Other - Org Name:THE BROWN MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
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:216-767-8793
Mailing Address - Fax:216-767-8778
Practice Address - Street 1:158 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2039
Practice Address - Country:US
Practice Address - Phone:216-767-8793
Practice Address - Fax:216-767-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1058662Medicaid
OH361308Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO