Provider Demographics
NPI: | 1114107919 |
---|---|
Name: | THE CHRIST HOSPITAL MEDICAL ASSOCIATES, LLC |
Entity type: | Organization |
Organization Name: | THE CHRIST HOSPITAL MEDICAL ASSOCIATES, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | VP, CHIEF BUSINESS OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VICTOR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DIPILLA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 513-585-1295 |
Mailing Address - Street 1: | 2139 AUBURN AVE # 4-9 |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45219-2906 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-351-9900 |
Mailing Address - Fax: | 513-366-4480 |
Practice Address - Street 1: | 2139 AUBURN AVE |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45219-2906 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-351-9900 |
Practice Address - Fax: | 513-366-4480 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | THE CHRIST HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-11-08 |
Last Update Date: | 2025-01-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100077920 | Medicaid | |
OH | DO4197 | Other | RAIL ROAD MEDICARE |
OH | 2958223 | Medicaid | |
KY | 7100077920 | Medicaid |