1740345339 NPI number — CITY OF CLEVELAND

Table of content: (NPI 1740345339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740345339 NPI number — CITY OF CLEVELAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CLEVELAND
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:
1740345339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 SAINT CLAIR AVE NE
Provider Second Line Business Mailing Address:
CLEVELAND DEPARTMENT OF PUBLIC HEALTH
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44114-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-664-3920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 SAINT CLAIR AVE
Provider Second Line Business Practice Location Address:
J. GLEN SMITH HEALTH CENTER
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44108-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-664-3891
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CDPH
Authorized Official Telephone Number:
216-664-6790

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1073 , 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: 1073 . This is a "ODADAS PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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