1649507815 NPI number — THE CLEVELAND CLINIC FOUNDATION

Table of content: (NPI 1649507815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649507815 NPI number — THE CLEVELAND CLINIC FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CLEVELAND CLINIC FOUNDATION
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:
Provider Other Organization Name Type Code:
6
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:
1649507815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 EUCLID AVE
Provider Second Line Business Mailing Address:
AC5B-137
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-448-4200
Provider Business Mailing Address Fax Number:
216-448-5603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3175 SCIENCE PARK DR
Provider Second Line Business Practice Location Address:
STE AC4-B100
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-7327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-448-4200
Provider Business Practice Location Address Fax Number:
216-448-5603
Provider Enumeration Date:
11/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LONGVILLE
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER AND CONTRO
Authorized Official Telephone Number:
216-636-7416

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 02-200335003 , 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: 3119815 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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