1629452750 NPI number — CLEVELAND CLINIC FOUNDATON

Table of content: (NPI 1629452750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629452750 NPI number — CLEVELAND CLINIC FOUNDATON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND CLINIC FOUNDATON
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:
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:
1629452750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 MAILE AVE
Provider Second Line Business Mailing Address:
DOWN UNIT
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-990-1907
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLEVELAND CLINIC FOUNDATION
Provider Second Line Business Practice Location Address:
R35
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-990-1907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BONHAM
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
330-990-1907

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  COA.17341-NP , 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: COA.17341-NP . This is a "OHIO BOARD OF NURSING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: RN.354139-1 . This is a "OHIO BOARD OF NURSING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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