1679514855 NPI number — GREATER CINCINNATI PERINATAL ASSOCIATES, LLC

Table of content: (NPI 1679514855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679514855 NPI number — GREATER CINCINNATI PERINATAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER CINCINNATI PERINATAL ASSOCIATES, LLC
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:
GREATER CINCINNATI PERINATAL
Provider Other Organization Name Type Code:
5
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:
1679514855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2830 VICTORY PKWY
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-245-3113
Provider Business Mailing Address Fax Number:
513-245-3110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN ST
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:
45219-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-584-4800
Provider Business Practice Location Address Fax Number:
513-584-0635
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUPRICH
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR BUSINESS ADMINISTRATOR
Authorized Official Telephone Number:
513-245-3103

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2403143 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2571042 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403116 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78904026 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403125 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403134 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65939696 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403152 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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