Provider Demographics
NPI:1093049900
Name:CLEVELAND CLINIC
Entity Type:Organization
Organization Name:CLEVELAND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, PEDIATRIC ANESTHESIA
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-444-5996
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:P21, DEPARTMENT OF PEDIATRIC ANESTHESIOLOGY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-5996
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:P21, DEPARTMENT OF PEDIATRIC ANESTHESIOLOGY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091798282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital