Provider Demographics
NPI:1659539344
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:MANAGED CARE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAIORANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-642-8165
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:216-642-8165
Mailing Address - Fax:216-642-1064
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-758-2528
Practice Address - Fax:330-758-2821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND CLINC FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1228IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01772Medicare PIN