Healthcare Provider Details

I. General information

NPI: 1972931731
Provider Name (Legal Business Name): HILLCREST HOSP/CLEV CLINIC HLTH SYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HTS OH
44124
US

IV. Provider business mailing address

6780 MAYFIELD RD
MAYFIELD HTS OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-4537
  • Fax: 440-312-7104
Mailing address:
  • Phone: 440-312-4537
  • Fax: 440-312-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020034350
License Number StateOH

VIII. Authorized Official

Name: MICHAEL WASCOVICH
Title or Position: SENIOR DIRECTOR
Credential: RPH
Phone: 216-445-2357