Provider Demographics
NPI:1417464504
Name:CIRCLE HEALTH SERVICES
Entity Type:Organization
Organization Name:CIRCLE HEALTH SERVICES
Other - Org Name:THE FREE MEDICAL CLINIC OF GREATER CLEVELAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADVANCE BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-721-4070
Mailing Address - Street 1:5955 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3936
Mailing Address - Country:US
Mailing Address - Phone:440-888-0300
Mailing Address - Fax:
Practice Address - Street 1:5955 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3936
Practice Address - Country:US
Practice Address - Phone:440-888-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082924Medicaid