1871997973 NPI number — MELINDA SHEPPARD

Table of content: MELINDA SHEPPARD (NPI 1871997973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871997973 NPI number — MELINDA SHEPPARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPPARD
Provider First Name:
MELINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALLINGER
Provider Other First Name:
MELINDA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871997973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 WILLIAM HOWARD TAFT RD
Provider Second Line Business Mailing Address:
2ND FLOOR, CBO 2-3
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-792-7800
Provider Business Mailing Address Fax Number:
513-792-7827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11140 MONTGOMERY RD
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:
45249-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-792-7800
Provider Business Practice Location Address Fax Number:
513-792-7827
Provider Enumeration Date:
10/17/2014

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: 363LA2200X , with the licence number:  16240 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 16240 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100314950 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".