MEDICARE: THE CLEVELAND CLINIC FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	02-0079600	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043291784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CLEVELAND CLINIC FOUNDATION

Provider Business Mailing Address
First Line	:	9211 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2043
Country	:	US
Telephone Number	:	216-444-2100
Fax Number	:	216-445-0025

Provider Business Practice Location Address
First Line	:	9211 EUCLID AVE
Second Line	:	JJ10 PHARMACY
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2043
Country	:	US
Telephone Number	:	216-444-2100
Fax Number	:	216-445-0025

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER AND CONTRO
Name	:	MR. TIM LONGVILLE
Credential	:
Telephone Number	:	216-636-7416

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	09/06/2023

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Directions to “THE CLEVELAND CLINIC FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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