1013967025 NPI number — CLEVELAND CENTER FOR DIGESTIVE

Table of content: (NPI 1013967025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013967025 NPI number — CLEVELAND CENTER FOR DIGESTIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND CENTER FOR DIGESTIVE
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:
Provider Other Organization Name Type Code:
6
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:
1013967025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 PARK EAST DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-593-7700
Provider Business Mailing Address Fax Number:
216-593-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 PARK EAST DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-593-7700
Provider Business Practice Location Address Fax Number:
216-593-7190
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDRASSY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CIO/ADMINISTRATOR
Authorized Official Telephone Number:
216-593-7502

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X , with the licence number:  0065AS , 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)

  • Identifier: 000000389849 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0621465 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7316076 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000389849 . This is a "ANTHEM- BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00304788 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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