1992963680 NPI number — CLINIC MEDICAL SERVICES COMPANY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992963680 NPI number — CLINIC MEDICAL SERVICES COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINIC MEDICAL SERVICES COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEVELAND CLINIC STAR IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992963680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 W CREEK RD
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-642-8165
Provider Business Mailing Address Fax Number:
216-642-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
652 YOUNGSTOWN WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44446-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-505-2280
Provider Business Practice Location Address Fax Number:
330-505-2286
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MAIORANA
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MANAGED CARE MANAGER
Authorized Official Telephone Number:
216-642-8165

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  1229IC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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