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General NPI Number Information
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NPI Number | 1811932049
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Entity Type | Organization
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Legal Business Name | MARYMOUNT HOSPITAL
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 12000 MCCRACKEN RD STE 151
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2964
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Country | US
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Telephone | 216-578-8822
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Fax | 216-587-8844
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Provider Business Mailing Address
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Address Line | PO BOX 931783
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City | CLEVELAND
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State | OH
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Zip | 44193-1884
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Country | US
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Telephone | 216-445-2357
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Fax | 216-445-0025
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER AND CONTRO
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Name | MR. TIM LONGVILLE
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Credential | MHA, RPH
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Telephone | 216-636-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021567350
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License Number State | OH
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