Provider Demographics
NPI:1902858152
Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
Other - Org Name:HILLCREST 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 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-449-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1019282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5000054OtherUNITED HEALTHCARE
OH100121OtherKAISER
OH000000157024OtherANTHEM
OH341235593-00OtherBUREAU WORKERS COMPENSATI
OH0668077OtherAETNA INSURANCE
OH0089998Medicaid
OH341235593-00OtherBUREAU WORKERS COMPENSATI
OH0089998Medicaid
OH=========-008OtherCHAMPUS