Provider Demographics
NPI:1033988928
Name:CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC
Entity type:Organization
Organization Name:CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-260-2357
Mailing Address - Street 1:300 ALLEN BRADLEY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6130
Mailing Address - Country:US
Mailing Address - Phone:407-307-7652
Mailing Address - Fax:
Practice Address - Street 1:300 ALLEN BRADLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6130
Practice Address - Country:US
Practice Address - Phone:844-746-8537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-20
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies