Provider Demographics
NPI:1407816085
Name:CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC
Entity type:Organization
Organization Name:CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-260-2357
Mailing Address - Street 1:150 SPRINGSIDE DR
Mailing Address - Street 2:SUITE B225
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2468
Mailing Address - Country:US
Mailing Address - Phone:330-865-6956
Mailing Address - Fax:330-865-6972
Practice Address - Street 1:300 ALLEN BRADLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6130
Practice Address - Country:US
Practice Address - Phone:330-865-6956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6742370001Medicare NSC
OH9339081Medicare PIN