1144219908 NPI number — HSC SURGICAL ASSOCIATES OF CINCINNATI, LLC

Table of content: (NPI 1144219908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144219908 NPI number — HSC SURGICAL ASSOCIATES OF CINCINNATI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HSC SURGICAL ASSOCIATES OF CINCINNATI, 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:
TRI STATE ENDOSCOPY 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:
1144219908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 VERNON PL
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-872-4538
Provider Business Mailing Address Fax Number:
513-872-7625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 VERNON PL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-872-4538
Provider Business Practice Location Address Fax Number:
513-872-7625
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SAFDI
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PHYSICIAN PARTNER
Authorized Official Telephone Number:
513-751-6667

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0032AS , 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: 0980827 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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