Provider Demographics
NPI:1043281330
Name:CLEVELAND REGIONAL MEDICAL CENTER, LP
Entity Type:Organization
Organization Name:CLEVELAND REGIONAL MEDICAL CENTER, LP
Other - Org Name:CLEVELAND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOPARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-381-8299
Mailing Address - Street 1:300 EAST CROCKETT
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4029
Mailing Address - Country:US
Mailing Address - Phone:281-593-1811
Mailing Address - Fax:281-605-4563
Practice Address - Street 1:300 EAST CROCKETT
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4029
Practice Address - Country:US
Practice Address - Phone:281-593-1811
Practice Address - Fax:281-605-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000108282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0485331OtherAETNA
55767OtherAMERIGROUP
TX137279905Medicaid
HH0155OtherBCBS
55767OtherSTARHEALTH
137279905OtherCOMMUNITY HEALTH CHOICE
TX450296Medicare Oscar/Certification
55767OtherAMERIGROUP