1134212004 NPI number — WILLIAM J NIEMES MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134212004 NPI number — WILLIAM J NIEMES MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J NIEMES MD INC
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:
ALLERGY & ASTHMA CARE INC
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:
1134212004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 RAY NORRISH DR # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-1520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-671-0799
Provider Business Mailing Address Fax Number:
513-671-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 RAY NORRISH DR # 2
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:
45246-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-671-0799
Provider Business Practice Location Address Fax Number:
513-671-0845
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHER
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
513-671-0799

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  35.093000 , 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: DF5846 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100256520A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 643419 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 928184 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000008215 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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