Provider Demographics
NPI:1194744144
Name:MT. CARMEL FAMILY MEDICINE, INC.
Entity type:Organization
Organization Name:MT. CARMEL FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-528-1505
Mailing Address - Street 1:PO BOX 631997
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0020
Mailing Address - Country:US
Mailing Address - Phone:513-528-1505
Mailing Address - Fax:513-528-5982
Practice Address - Street 1:473 OLD STATE ROUTE 74
Practice Address - Street 2:SUITE 4
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244
Practice Address - Country:US
Practice Address - Phone:513-528-1505
Practice Address - Fax:513-528-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196225Medicaid
OH000000075155OtherANTHEM
OH2196225Medicaid