Provider Demographics
NPI:1023362100
Name:CLEVELAND CLINIC MERCY HOSPITAL
Entity type:Organization
Organization Name:CLEVELAND CLINIC MERCY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP CHIEF FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-445-1343
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:STE 20, ATTN: DPC RK2-7
Mailing Address - City:INDPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1459 SUPERIOR AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-1964
Practice Address - Country:US
Practice Address - Phone:330-588-4893
Practice Address - Fax:330-453-2793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-29
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH360070Medicare Oscar/Certification