1528050481 NPI number — KEVIN P REDMOND MD

Table of content: KEVIN P REDMOND MD (NPI 1528050481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528050481 NPI number — KEVIN P REDMOND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDMOND
Provider First Name:
KEVIN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1528050481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 GOODMAN 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:
45219-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-584-3494
Provider Business Mailing Address Fax Number:
513-584-4007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN ST
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:
45219-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-584-3494
Provider Business Practice Location Address Fax Number:
513-584-4007
Provider Enumeration Date:
08/17/2005

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: 2085R0001X , with the licence number:  35-04-9201 , 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: 920000712 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P8B037461 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200039310A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16-21000 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64787138 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3003880000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0655266 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0627638 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 295801 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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