Basic Information
| Provider Information | |||||||||
| NPI: | 1891042909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND CLINIC SUPPORT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 672 WALTHAM ST | ||||||||
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| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024217903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 W CREEK RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
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| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ACCT OFFICER & CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2164458990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.