1407844657 NPI number — GREATER CINCINNATI PATHOLOGISTS, INC

Table of content: (NPI 1407844657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407844657 NPI number — GREATER CINCINNATI PATHOLOGISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER CINCINNATI PATHOLOGISTS, 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:
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:
1407844657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 631104
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:
45263-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-365-3744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 HOME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45121-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-585-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NAZEK
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-585-7600

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , 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: 000000014990 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0833352 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI4525 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100024830B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100024830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65920019 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100024830D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC5953 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CI2528 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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