1437104098 NPI number — QUEEN CITY EAR NOSE AND THROAT ASSOC INC

Table of content: (NPI 1437104098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437104098 NPI number — QUEEN CITY EAR NOSE AND THROAT ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEEN CITY EAR NOSE AND THROAT ASSOC 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:
1437104098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 706187
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:
45270-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-793-9600
Provider Business Mailing Address Fax Number:
513-793-4928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11135 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:
45249-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-793-9600
Provider Business Practice Location Address Fax Number:
513-793-4928
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEUTSCH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-793-9600

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0405003 . This is a "MEDICARE PIN-SGL-MONTGOMERY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0026626 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0173039 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0240171 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0373091 . This is a "MEDICARE PIN-RM-MONTGOMERY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0802291 . This is a "MEDICARE PIN -MONTGOMERY-MDD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4064261 . This is a "MEDICARE PIN-ELS-MONTGOMERY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CJ8475 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0802297 . This is a "MEDICARE PIN-MDD-WILMINGTON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4064262 . This is a "MEDICARE PIN-ELS-WILMINGTON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0950798 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2253181 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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