1548297807 NPI number — QUEEN CITY GENERAL & VASCULAR SURGEONS GROUP LTD

Table of content: (NPI 1548297807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548297807 NPI number — QUEEN CITY GENERAL & VASCULAR SURGEONS GROUP LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEEN CITY GENERAL & VASCULAR SURGEONS GROUP LTD
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:
6
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:
1548297807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1270 SOLUTIONS CENTER
Provider Second Line Business Mailing Address:
PO BOX 771270
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-542-6898
Provider Business Mailing Address Fax Number:
513-542-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7502 STATE RD
Provider Second Line Business Practice Location Address:
STE. 1180
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45255-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-232-8181
Provider Business Practice Location Address Fax Number:
513-624-2964
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERTEL
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
513-232-8181

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200293310B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2066026 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2066035 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2066044 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200293310E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2065867 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2324336 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200293310A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200293310C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200293310D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD8400 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2066053 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2066017 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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