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General NPI Number Information
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NPI Number | 1376989574
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Entity Type | Organization
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Legal Business Name | THE FREE MEDICAL CLINIC OF GREATER CLEVELAND
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 12201 EUCLID AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-707-4010
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Fax |
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Provider Business Mailing Address
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Address Line | 12201 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-4310
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Country | US
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Telephone | 216-707-4010
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | AMANDA MILLER
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Credential |
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Telephone | 216-707-3408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | E. 0007322
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License Number State | OH
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