1306890181 NPI number — SUSAN J. ROSSI M.D.

Table of content: KIMBERLYN NANETTA KELLEY OTD, OTR/L (NPI 1336324110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306890181 NPI number — SUSAN J. ROSSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSI
Provider First Name:
SUSAN
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1306890181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636930
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:
45263-6930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-981-5123
Provider Business Mailing Address Fax Number:
513-981-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-3990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-226-4300
Provider Business Practice Location Address Fax Number:
419-226-4305
Provider Enumeration Date:
05/19/2006

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: 207Y00000X , with the licence number:  35-08-3337 , 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: 1306890181 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3004898000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310917085134 . This is a "CARESOURCE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2500234 . This is a "MOLINA MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00066040 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000181653 . This is a "UNISON MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000310729 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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