1811693229 NPI number — CINCY ARTHRITIS

Table of content: (NPI 1811693229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811693229 NPI number — CINCY ARTHRITIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CINCY ARTHRITIS
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:
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:
1811693229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9403 KENWOOD RD STE C100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-6857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-991-9990
Provider Business Mailing Address Fax Number:
513-991-9989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9403 KENWOOD RD STE C100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE ASH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-6857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-991-9990
Provider Business Practice Location Address Fax Number:
513-991-9989
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
GABRIELA
Authorized Official Title or Position:
PROVIDER ENROLLMENT COORDINATOR
Authorized Official Telephone Number:
561-425-9483

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3081767 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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