1043281330 NPI number — CLEVELAND REGIONAL MEDICAL CENTER, LP

Table of content: (NPI 1043281330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043281330 NPI number — CLEVELAND REGIONAL MEDICAL CENTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND REGIONAL MEDICAL CENTER, LP
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:
1043281330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 EAST CROCKETT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77327-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-593-1811
Provider Business Mailing Address Fax Number:
281-605-4563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 EAST CROCKETT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77327-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-593-1811
Provider Business Practice Location Address Fax Number:
281-605-4563
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOPARTY
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
832-381-8299

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0485331 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55767 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137279905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0155 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55767 . This is a "STARHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137279905 . This is a "COMMUNITY HEALTH CHOICE" identifier . This identifiers is of the category "OTHER".




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