Healthcare Provider Details

I. General information

NPI: 1649507815
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SCIENCE PARK DR STE AC4-B100
BEACHWOOD OH
44122-7327
US

IV. Provider business mailing address

9500 EUCLID AVE AC5B-137
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-448-4200
  • Fax: 216-448-5603
Mailing address:
  • Phone: 216-448-4200
  • Fax: 216-448-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number02-200335003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM LONGVILLE
Title or Position: CHIEF ACCOUNTING OFFICER AND CONTRO
Credential:
Phone: 216-636-7416