Provider Demographics
NPI:1740787068
Name:CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
Other - Org Name:CLEVELAND CLINIC FLORIDA CORAL SPRINGS ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCT OFFICER & CONTROLLER,CCF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:SUITE 20, RK2-7
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-636-4969
Mailing Address - Fax:216-442-1272
Practice Address - Street 1:5701 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067
Practice Address - Country:US
Practice Address - Phone:877-463-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical