MEDICARE: CLEVELAND MEDICAL CLINIC INC

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	208VP0000X	Pain Medicine Physician
2	208M00000X	Hospitalist Physician

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

General Provider Information

NPI Number	:	1720149222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 CHAMBLISS AVE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320
Country	:	US
Telephone Number	:	423-559-6000
Fax Number	:	423-559-6653

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7000

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/13/2008

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Directions to “CLEVELAND MEDICAL CLINIC INC ” Practice Location

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