Provider Demographics
NPI:1235183542
Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Other - Org Name:SOUTH POINTE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCT. OFFICER AND CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
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 1:4110 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-491-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1297282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100120OtherKAISER
OH8552507Medicaid
OH340811464-00OtherBUREAU WORKERS COMPENSATI
OH5000056OtherUNITED HEALTH CARE
OH000000157027OtherANTHEM
OH0062834OtherAETNA
OH0062834OtherAETNA
OH340811464-00OtherBUREAU WORKERS COMPENSATI
OH8552507Medicaid