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1235127408

NPI Code Detail

MEDICARE: CLINIC PHYSICIAN SERVICES CO. LLC

MEDICARE: CLINIC PHYSICIAN SERVICES CO. 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	208VP0014X	Interventional Pain Medicine Physician
2	207L00000X	Anesthesiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	CG8024	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235127408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC PHYSICIAN SERVICES CO. LLC

Provider Business Mailing Address
First Line	:	6801 BRECKSVILLE RD
Second Line	:	RK1-19
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-5032
Country	:	US
Telephone Number	:	216-442-1840
Fax Number	:

Provider Business Practice Location Address
First Line	:	6780 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2203
Country	:	US
Telephone Number	:	440-312-4500
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER AND CONTRO
Name	:	MR. TIM LONGVILLE
Credential	:
Telephone Number	:	216-636-7416

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	02/23/2022

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Directions to “CLINIC PHYSICIAN SERVICES CO. LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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