Provider Demographics
NPI:1275588766
Name:CLEVELAND CLINIC FOUNDATION FAIRVIEW HOSPITAL
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FOUNDATION FAIRVIEW HOSPITAL
Other - Org Name:FAIRVIEW HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-444-9361
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:SUITE 20 RK10
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5032
Mailing Address - Country:US
Mailing Address - Phone:216-636-8051
Mailing Address - Fax:216-636-8088
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1145273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
5000023OtherUNITED HEALTHCARE
0017966OtherCHAMPUS
OH100127OtherKAISER
0062685OtherAETNA
OH2633565Medicaid
000000075192OtherANTHEM
OH100127OtherKAISER
OH=========092OtherMEDICAL MUTUAL OF OHIO
0017966OtherCHAMPUS