Provider Demographics
NPI:1386696847
Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Entity type:Organization
Organization Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-444-9361
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:SUITE 20 RK 10
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5032
Mailing Address - Country:US
Mailing Address - Phone:216-636-8052
Mailing Address - Fax:
Practice Address - Street 1:13951 TERRACE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4308
Practice Address - Country:US
Practice Address - Phone:216-761-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1148282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4195517Medicaid
OH100119OtherKAISER
OH000000157025OtherANTHEM
OH340714435-00OtherBUREAU WORKERS COMPENSATI
OH0081812OtherAETNA
OH5000055OtherUNITED HEALTHCARE
OH=========-005OtherCHAMPUS
OH5000055OtherUNITED HEALTHCARE
OH4195517Medicaid