Healthcare Provider Details

I. General information

NPI: 1033549712
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 ROCKSIDE RD CROWN CENTER #2
INDEPENDENCE OH
44131-2172
US

IV. Provider business mailing address

9500 EUCLID AVE JJ10
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-986-4610
  • Fax: 216-445-0025
Mailing address:
  • Phone: 216-445-2357
  • Fax: 216-445-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022360800
License Number StateOH

VIII. Authorized Official

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