1346226388 NPI number — CHARLES W ABBOTTSMITH M.D.

Table of content: CHARLES W ABBOTTSMITH M.D. (NPI 1346226388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346226388 NPI number — CHARLES W ABBOTTSMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOTTSMITH
Provider First Name:
CHARLES
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1346226388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 WILLIAM HOWARD TAFT RD
Provider Second Line Business Mailing Address:
2ND FLOOR, CBO 2-3
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-206-1060
Provider Business Mailing Address Fax Number:
513-206-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2123 AUBURN AVE
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-206-1060
Provider Business Practice Location Address Fax Number:
513-206-1062
Provider Enumeration Date:
12/21/2005

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: 207RC0000X , with the licence number:  35029506 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 35.029506 , 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: 64787617 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100009840 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 283677 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 641388 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 29506-05 . This is a "HUMANA CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000019879 . This is a "ANTHEM CINCINNATI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0380083 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060033890 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2520405 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000238154 . This is a "ANTHEM MIDDLETOWN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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