1649253469 NPI number — DR. JOHN W NURRE II MD

Table of content: DR. JOHN W NURRE II MD (NPI 1649253469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649253469 NPI number — DR. JOHN W NURRE II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NURRE
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
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:
1649253469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4685 FOREST AVE STE C
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:
45212-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-246-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6949 GOOD SAMARITAN DRIVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45247-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-246-7000
Provider Business Practice Location Address Fax Number:
513-246-8855
Provider Enumeration Date:
11/25/2005

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: 174400000X , with the licence number:  35053595 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 35.053595 , 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: 0701271 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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