1477592384 NPI number — DR. JESSICA D HILDENBRAND OD

Table of content: DR. JESSICA D HILDENBRAND OD (NPI 1477592384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477592384 NPI number — DR. JESSICA D HILDENBRAND OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILDENBRAND
Provider First Name:
JESSICA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1477592384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4445 LAKE FOREST DR
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-569-3741
Provider Business Mailing Address Fax Number:
513-569-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 CEI DRIVE
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:
45242-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-569-3741
Provider Business Practice Location Address Fax Number:
513-569-3941
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1410DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 4938T1808 , 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: 77540359 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2037114 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410037092 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200196940 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000020793 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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