Provider Demographics
NPI:1063532430
Name:CHEVIOT MEDICAL CENTER INC
Entity type:Organization
Organization Name:CHEVIOT MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRILAKSHMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PISATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-481-9100
Mailing Address - Street 1:3502 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5726
Mailing Address - Country:US
Mailing Address - Phone:513-481-9100
Mailing Address - Fax:513-389-7052
Practice Address - Street 1:3502 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5726
Practice Address - Country:US
Practice Address - Phone:513-481-9100
Practice Address - Fax:513-389-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119139Medicaid
OHG68023Medicare UPIN
OH2119139Medicaid