=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366514093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEVELAND CLINIC HEALTH SYSTEMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 NORTHLINE CIR SUITE 211
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44119-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-692-7826
-----------------------------------------------------
Fax | 216-692-7499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9500 EUCLID AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-692-7826
-----------------------------------------------------
Fax | 216-692-7499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. DELROS COSGROVE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 216-444-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | E0002458
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------