1083098016 NPI number — MIDWEST EYE SURGERY CENTER

Table of content: (NPI 1083098016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083098016 NPI number — MIDWEST EYE SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST EYE SURGERY CENTER
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:
1083098016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 CHANCELLOR DR
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
CRESTVIEW HILLS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-344-2079
Provider Business Mailing Address Fax Number:
859-581-7207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4452 EASTGATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45245-1584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-752-5700
Provider Business Practice Location Address Fax Number:
513-752-5716
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARBERY
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
859-344-2062

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0132X , with the licence number: 0087AS , 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: 0163517 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100401680 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490002965 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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