Provider Demographics
NPI:1770053944
Name:CASE WESTERN RESERVE UNIVERSITY
Entity type:Organization
Organization Name:CASE WESTERN RESERVE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-368-8630
Mailing Address - Street 1:10900 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4901
Mailing Address - Country:US
Mailing Address - Phone:216-368-6150
Mailing Address - Fax:216-368-8530
Practice Address - Street 1:2145 ADELBERT ROAD - UNIVERSITY HEALTH SERVICE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4901
Practice Address - Country:US
Practice Address - Phone:216-368-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASE WESTERN RESERVE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health