1144236969 NPI number — DIABETES & ENDOCRINOLOGY ASSOC INC

Table of content: (NPI 1144236969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144236969 NPI number — DIABETES & ENDOCRINOLOGY ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETES & ENDOCRINOLOGY ASSOC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144236969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4360 COOPER RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-861-0012
Provider Business Mailing Address Fax Number:
513-861-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4360 COOPER RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-861-0012
Provider Business Practice Location Address Fax Number:
513-861-2220
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-861-0012

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2086755 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0929565 . This is a "AETNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1052453 . This is a "MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CL1292 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".