Basic Information
| Provider Information | |||||||||
| NPI: | 1043281330 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEVELAND REGIONAL MEDICAL CENTER, LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLEVELAND REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 EAST CROCKETT | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773274029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815931811 | ||||||||
| FaxNumber: | 2816054563 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 EAST CROCKETT | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773274029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815931811 | ||||||||
| FaxNumber: | 2816054563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOPARTY | ||||||||
| AuthorizedOfficialFirstName: | RAVI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8323818299 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000108 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0485331 | 01 | AETNA | OTHER | 55767 | 01 | AMERIGROUP | OTHER | 137279905 | 05 | TX | MEDICAID | HH0155 | 01 | BCBS | OTHER | 55767 | 01 | STARHEALTH | OTHER | 137279905 | 01 | COMMUNITY HEALTH CHOICE | OTHER |