1730681982 NPI number — MS. JULIE LYNN ROE PC

Table of content: MS. JULIE LYNN ROE PC (NPI 1730681982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730681982 NPI number — MS. JULIE LYNN ROE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROE
Provider First Name:
JULIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHOCKLEY
Provider Other First Name:
JULIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NONE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730681982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4516 ROSS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45005-4893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-393-2263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7162 READING RD STE 300
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:
45237-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-961-5900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2018

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: 101Y00000X , with the licence number:  C.1200385 , 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: C.1200385 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".