Provider Demographics
NPI:1528013984
Name:CLINIC MEDICAL SERVICES COMPANY
Entity Type:Organization
Organization Name:CLINIC MEDICAL SERVICES COMPANY
Other - Org Name:CLEVELAND CLINIC STAR IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER AND CONTRO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7148
Mailing Address - Street 1:6100 W CREEK RD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2133
Mailing Address - Country:US
Mailing Address - Phone:216-986-4665
Mailing Address - Fax:216-642-1064
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-642-8165
Practice Address - Fax:216-642-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197993Medicaid
OHCL9311996Medicare ID - Type Unspecified