Provider Demographics
NPI:1194950550
Name:TIMELESS AESTHETICS, LLC
Entity type:Organization
Organization Name:TIMELESS AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-619-5006
Mailing Address - Street 1:3260 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5107
Mailing Address - Country:US
Mailing Address - Phone:513-451-9600
Mailing Address - Fax:513-347-2116
Practice Address - Street 1:3260 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5107
Practice Address - Country:US
Practice Address - Phone:513-451-9600
Practice Address - Fax:513-347-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1594262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty