Basic Information
| Provider Information | |||||||||
| NPI: | 1508091216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND REGIONAL MEDICAL CENTER, LP | ||||||||
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| OtherOrganizationName: | CLEVELAND REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E CROCKETT ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773274029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
| FaxNumber: | 2816054563 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E CROCKETT ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773274029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
| FaxNumber: | 2816054563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2009 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOPARTY | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8323818299 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.