1689132797 NPI number — THE CLEVELAND CLINIC FOUNDATION

Table of content: (NPI 1689132797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689132797 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:
CCF COLE EYE LAKEWOOD
Provider Other Organization Name Type Code:
3
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:
1689132797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 BRECKSVILLE ROAD
Provider Second Line Business Mailing Address:
SUITE 20 RK2-7
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-5058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-636-8926
Provider Business Mailing Address Fax Number:
216-442-1272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16215 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-5618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-237-5888
Provider Business Practice Location Address Fax Number:
216-521-3338
Provider Enumeration Date:
03/07/2019

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: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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