Healthcare Provider Details

I. General information

NPI: 1811979420
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 E 100TH ST
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

2049 E 100TH ST
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-7400
  • Fax: 216-445-7403
Mailing address:
  • Phone: 216-445-7400
  • Fax: 216-445-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number02-0925550
License Number StateOH

VIII. Authorized Official

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