=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760799753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CLEVELAND CLINIC FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2010
-----------------------------------------------------
Last Update Date | 01/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7010 ENGLE RD STE 105
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-263-3733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 W CREEK RD STE 10
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44131-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-223-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DANIEL MEDVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-973-3321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------