Provider Demographics
NPI:1003860487
Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Other - Org Name:EUCLID HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCT OFFICER AND CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7146
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:216-636-8088
Practice Address - Street 1:18901 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1078
Practice Address - Country:US
Practice Address - Phone:216-531-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1133273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
5000053OtherUNITED HEALTHCARE
OH2593420Medicaid
OH000000157022OtherANTHEM
OH100118OtherKAISER
OH0059416OtherAETNA
OH340714616-00OtherBUREAU WORKERS COMPENSATI
OH000000157022OtherANTHEM
OH340714616-00OtherBUREAU WORKERS COMPENSATI
OH36-T082Medicare Oscar/Certification