Provider Demographics
NPI:1306928072
Name:CLERMONT COUNTY COMMUNITY SERVICES INC.
Entity type:Organization
Organization Name:CLERMONT COUNTY COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-732-2277
Mailing Address - Street 1:3003 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2689
Mailing Address - Country:US
Mailing Address - Phone:513-732-2277
Mailing Address - Fax:513-735-8839
Practice Address - Street 1:3003 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2689
Practice Address - Country:US
Practice Address - Phone:513-732-2277
Practice Address - Fax:513-735-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0850002Medicaid