1164833604 NPI number — UNIVERSITY OF CINCINNATI MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164833604 NPI number — UNIVERSITY OF CINCINNATI MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CINCINNATI MEDICAL 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:
1164833604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF CINCINNATI PHYSICAL MEDICINE
Provider Second Line Business Mailing Address:
PO BOX 670530
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45267-0530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-558-2919
Provider Business Mailing Address Fax Number:
513-558-4458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 STETSON STREET
Provider Second Line Business Practice Location Address:
SUITE 5200
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-558-2919
Provider Business Practice Location Address Fax Number:
513-558-4458
Provider Enumeration Date:
05/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
QUARLES
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
RESIDENT PHYSICIAN
Authorized Official Telephone Number:
423-914-3425

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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