Organization
CLINIC PHYSICIAN SERVICES CO. LLC
Active
Organization
CLINIC PHYSICIAN SERVICES CO. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM LONGVILLE (CHIEF ACCOUNTING OFFICER AND CONTRO)
(216) 636-7416
Entity
Organization
Contact information
Practice address
6780 MAYFIELD RD, MAYFIELD HTS, OH 44124-2203
(440) 312-4500
Mailing address
6801 BRECKSVILLE RD, RK1-19, INDEPENDENCE, OH 44131-5032
(216) 442-1840
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2173615
—
OH
05
—
2173651
—
OH
05
—
2173660
—
OH
05
—
2175882
—
OH
05
—
2178272
—
OH
05
—
2178290
—
OH
05
—
2355099
—
OH
05
—
2475165
—
OH
05
—
2545811
—
OH
01
—
CG8024
RAILROAD MEDICARE
OH
Enumeration date
10/11/2005
Last updated
02/23/2022
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up