1689660631 NPI number — DUAL CC, INC.

Table of content: (NPI 1689660631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689660631 NPI number — DUAL CC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUAL CC, 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:
DUAL MANOR
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:
1689660631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 MARTIN LUTHER KING DR E
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:
45229-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-961-2853
Provider Business Mailing Address Fax Number:
513-487-6885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 MARTIN LUTHER KING DR E
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:
45229-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-961-2853
Provider Business Practice Location Address Fax Number:
513-487-6885
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JAMISON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-751-4900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  520009 , 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: 2472640 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5491620001 . This is a "DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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