1285625392 NPI number — DANTE RANESES MD

Table of content: (NPI 1285625392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285625392 NPI number — DANTE RANESES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANTE RANESES MD
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:
COLERAIN FAMILY CARE CENTER
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:
1285625392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NORTHLAND BLVD
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-672-4128
Provider Business Mailing Address Fax Number:
513-672-4479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5944 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:
513-385-4757
Provider Business Practice Location Address Fax Number:
513-385-9485
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RANESES
Authorized Official First Name:
DANTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-672-3300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 0538985 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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