1851560346 NPI number — WINTON HILLS MEDICAL AND HEALTH CENTER, INC.

Table of content: MRS. MARY JO PATINO COFREROS ARNP (NPI 1700286440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851560346 NPI number — WINTON HILLS MEDICAL AND HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTON HILLS MEDICAL AND HEALTH CENTER, INC.
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:
1851560346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5275 WINNESTE AVE
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:
45232-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-242-1033
Provider Business Mailing Address Fax Number:
513-244-1539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 OAK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-242-1033
Provider Business Practice Location Address Fax Number:
513-242-1539
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CRENSHAW
Authorized Official First Name:
MIRIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-242-1033

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2856860 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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