Provider Demographics
| NPI: | 1881634665 |
|---|---|
| Name: | CHILDRENS RESEARCH FOUNDATION OF CLEVELAND |
| Entity Type: | Organization |
| Organization Name: | CHILDRENS RESEARCH FOUNDATION OF CLEVELAND |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRACTICE ADMINSTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | RANDY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BREININGER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 216-844-7700 |
| Mailing Address - Street 1: | 3605 WARRENSVILLE CENTER RD |
| Mailing Address - Street 2: | 1ST FLOOR - MSC 9152 |
| Mailing Address - City: | SHAKER HEIGHTS |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44122-5203 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 216-286-6299 |
| Mailing Address - Fax: | 216-286-6341 |
| Practice Address - Street 1: | 11100 EUCLID AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | CLEVELAND |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44106-1736 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 216-844-7700 |
| Practice Address - Fax: | 216-286-6341 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-08 |
| Last Update Date: | 2008-04-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
| No | 2080P0204X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | Group - Multi-Specialty |
| No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
| No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
| No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
| No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
| No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
| No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
| No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 0557375 | Medicaid | |
| OH | CH9910 | Other | RAILROAD MEDICARE |
| OH | CH9910 | Other | RAILROAD MEDICARE |
| OH | CH9910 | Other | RAILROAD MEDICARE |
