1215989611 NPI number — FAIRVIEW HOSPITAL

Table of content: (NPI 1215989611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215989611 NPI number — FAIRVIEW HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEVELAND CLINIC FOUNDATION FAIRVIEW HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215989611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 BRECKSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 20 RK10
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-636-8051
Provider Business Mailing Address Fax Number:
216-636-8088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 LORAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44111-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-476-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LONGVILLE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHIEF ACCT. OFFICER AND CONTROLLER
Authorized Official Telephone Number:
216-636-7416

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  1145 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2633565 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000023 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0062685 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100127 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




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