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General NPI Number Information
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NPI Number | 1881775492
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Entity Type | Organization
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Legal Business Name | FAIRVIEW HOSPITAL
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1730 W 25TH ST SUITE 1A
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City | CLEVELAND
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State | OH
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Zip | 44113-3108
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Country | US
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Telephone | 216-363-2120
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Fax | 216-696-2856
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Provider Business Mailing Address
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Address Line | 1730 W 25TH ST SUITE 1A
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City | CLEVELAND
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State | OH
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Zip | 44113-3108
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Country | US
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Telephone | 216-363-2120
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Fax | 216-696-2856
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Authorized Official
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Title or Position | COO
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Name | JERRY P OLIPHANT
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Credential |
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Telephone | 216-939-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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