Provider Demographics
NPI:1346282324
Name:THE METROHEALTH SYSTEM
Entity Type:Organization
Organization Name:THE METROHEALTH SYSTEM
Other - Org Name:METROHEALTH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-778-7800
Mailing Address - Street 1:4229 PEARL RD
Mailing Address - Street 2:ATTN: LINDA GREENHILL PFS SVR RM 2-20-20
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4218
Mailing Address - Country:US
Mailing Address - Phone:216-957-2442
Mailing Address - Fax:216-957-2404
Practice Address - Street 1:3701 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3707
Practice Address - Country:US
Practice Address - Phone:216-778-8046
Practice Address - Fax:216-957-4801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE METROHEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122400000XDental ProvidersDenturistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty
No126900000XDental ProvidersDental Laboratory TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA1240OtherRAIL ROAD MEDICARE
OH2005029Medicaid
OH2005029Medicaid
OH2005029Medicaid
OHCA1240OtherRAIL ROAD MEDICARE