MEDICARE: CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1407816085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND ORTHOPEDIC AND SPINE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	150 SPRINGSIDE DR
Second Line	:	SUITE B225
City	:	AKRON
State	:	OH
Zip	:	44333-2468
Country	:	US
Telephone Number	:	330-865-6956
Fax Number	:	330-865-6972

Provider Business Practice Location Address
First Line	:	300 ALLEN BRADLEY DR STE 200
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6130
Country	:	US
Telephone Number	:	330-865-6956
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	MARY EBERT
Credential	:
Telephone Number	:	614-260-2357

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	04/14/2025

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