Provider Demographics
NPI:1013967025
Name:CLEVELAND CENTER FOR DIGESTIVE
Entity Type:Organization
Organization Name:CLEVELAND CENTER FOR DIGESTIVE
Other - Org Name:CLEVELAND CENTER FOR DIGESTIVE HEALTH AND ENDOSCOPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDRASSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-593-7502
Mailing Address - Street 1:3700 PARK EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4339
Mailing Address - Country:US
Mailing Address - Phone:216-593-7700
Mailing Address - Fax:216-593-7190
Practice Address - Street 1:3700 PARK EAST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4339
Practice Address - Country:US
Practice Address - Phone:216-593-7700
Practice Address - Fax:216-593-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0065AS261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389849OtherANTHEM BCBS
OH0621465Medicaid
OH7316076OtherAETNA
OH000000389849OtherANTHEM- BLUE CROSS & BLUE SHIELD
OHP00304788OtherRAILROAD MEDICARE
OH000000389849OtherANTHEM- BLUE CROSS & BLUE SHIELD
OH0621465Medicaid