Healthcare Provider Details

I. General information

NPI: 1376989574
Provider Name (Legal Business Name): THE FREE MEDICAL CLINIC OF GREATER CLEVELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVENUE
CLEVELAND OH
44106
US

IV. Provider business mailing address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 216-707-4010
  • Fax:
Mailing address:
  • Phone: 216-707-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE. 0007322
License Number StateOH

VIII. Authorized Official

Name: AMANDA MILLER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 216-707-3408