MEDICARE: FAIRVIEW HOSPITAL

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1396838231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	2709 FRANKLIN BLVD
Second Line	:	SUITE 4C
City	:	CLEVELAND
State	:	OH
Zip	:	44113-2993
Country	:	US
Telephone Number	:	440-333-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 FRANKLIN BLVD
Second Line	:	SUITE 4C
City	:	CLEVELAND
State	:	OH
Zip	:	44113-2993
Country	:	US
Telephone Number	:	440-333-3332
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JERRY OLIPHANT
Credential	:
Telephone Number	:	216-939-8835

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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Directions to “FAIRVIEW HOSPITAL ” Practice Location

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