1174565931 NPI number — DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174565931 NPI number — DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS URGENT CARE OFFICES MEDICAL GROUP 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:
DOCTORS URGENT CARE OFFICE
Provider Other Organization Name Type Code:
3
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:
1174565931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 STATE ROUTE 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45150-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-831-5955
Provider Business Mailing Address Fax Number:
513-831-5985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5920 COLERAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45239-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-741-7044
Provider Business Practice Location Address Fax Number:
513-741-0718
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMRHEIN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-831-5955

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  NOT APPLICABLE , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36D00662506 . This is a "CLIA WAIVER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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