Provider Demographics
NPI:1891091559
Name:CLEVELAND CLINIC FOUNDATION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-444-2200
Mailing Address - Street 1:1127 EUCLID AVE APT 1422
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1617
Mailing Address - Country:US
Mailing Address - Phone:347-641-0812
Mailing Address - Fax:
Practice Address - Street 1:1127 EUCLID AVE
Practice Address - Street 2:APARTMENT 1422
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1601
Practice Address - Country:US
Practice Address - Phone:347-641-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital