Marymount Hospital

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

021567350 Issued in OH

Legal business name

MARYMOUNT HOSPITAL

Practice address

12000 McCracken Rd
Ste 151
Garfield Heights, OH 44125-2964

Phone

(216) 578-8822

Fax

(216) 587-8844

NPI assigned

Jun 19, 2006

Organization subpart

No

Name

Mr. Tim Longville, MHA, RPH

Title

Chief Accounting Officer and Contro

Phone

(216) 636-7416

Organizations this organization is a member of, according to the National Provider Directory.

• Cleveland Clinic Foundation

  • Durable Medical Equipment & Medical Supplies
  • Sheffield Village, OH
  • NPI 1942405741

  Member Of

  NPD member

Locations

• MARYMOUNT FAMILY PHARMACY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 11, 2023.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1811932049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931783",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441931884",
            "telephone_number": "216-445-2357",
            "fax_number": "216-445-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 MCCRACKEN RD",
            "address_2": "STE 151",
            "city": "GARFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441252964",
            "telephone_number": "216-578-8822",
            "fax_number": "216-587-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "LONGVILLE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER AND CONTRO",
        "authorized_official_telephone_number": "216-636-7416",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA, RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021567350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3674101",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARYMOUNT FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MARYMOUNT FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Latasha Martin
• Louis C Martin, CDCA
• Tara M Martin
• Marymount Healthcare, LLC
• Marymount Healthcare, LLC
• Marymount Hospital Inc
• Marymount Hospital Inc
• Marymount Hospital Inc
• Marymount Hospital, Inc.
• Marymount Primary Care Services, Inc

• All providers in Garfield Heights, OH
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.