1245561265 NPI number — THE BACK CARE SHOP, INC. DBA BIOWORKS

Table of content: (NPI 1245561265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245561265 NPI number — THE BACK CARE SHOP, INC. DBA BIOWORKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BACK CARE SHOP, INC. DBA BIOWORKS
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:
1245561265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7791 COOPER RD
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-7734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-793-7335
Provider Business Mailing Address Fax Number:
513-985-3865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2960 MACK RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-874-1939
Provider Business Practice Location Address Fax Number:
513-874-0169
Provider Enumeration Date:
01/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRILL
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
513-793-7335

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9025425100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0575408 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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