1952472995 NPI number — MR. ALAN L GROSS LISW

Table of content: MR. ALAN L GROSS LISW (NPI 1952472995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952472995 NPI number — MR. ALAN L GROSS LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS
Provider First Name:
ALAN
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
M

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:
1952472995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E MCMILLAN ST
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:
45206-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-487-7174
Provider Business Mailing Address Fax Number:
513-475-5689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8260 NORTHCREEK DRIVE
Provider Second Line Business Practice Location Address:
#380
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45236-6117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-271-0803
Provider Business Practice Location Address Fax Number:
513-272-4132
Provider Enumeration Date:
11/13/2006

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: 101YM0800X , with the licence number:  I0007705 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: I0007705 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: I0007705 . This is a "LISW" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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