Provider Demographics
NPI:1194723676
Name:QUEEN CITY SPORTS MEDICINE AND ORTHOPEDICS
Entity type:Organization
Organization Name:QUEEN CITY SPORTS MEDICINE AND ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TURBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-561-1111
Mailing Address - Street 1:3950 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3429
Mailing Address - Country:US
Mailing Address - Phone:513-561-1111
Mailing Address - Fax:513-561-1241
Practice Address - Street 1:3950 RED BANK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3429
Practice Address - Country:US
Practice Address - Phone:513-561-1111
Practice Address - Fax:513-561-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH036587207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74779Medicare UPIN