1578501193 NPI number — ADVANCED BARIATRIC CENTERS

Table of content: (NPI 1578501193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578501193 NPI number — ADVANCED BARIATRIC CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED BARIATRIC CENTERS
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:
1578501193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 GREENWELL AVE
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:
45238-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-557-3507
Provider Business Mailing Address Fax Number:
513-557-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-426-7000
Provider Business Practice Location Address Fax Number:
859-426-7010
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMTIH
Authorized Official First Name:
DWAYNE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
859-426-7000

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  23626 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2268148 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com