Provider Demographics
| NPI: | 1417108697 |
|---|---|
| Name: | UNIVERSITY OF CINCINNATI PHYSICIANS, INC. |
| Entity type: | Organization |
| Organization Name: | UNIVERSITY OF CINCINNATI PHYSICIANS, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CREDENTIALING MANAGER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | LISA |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | HUNT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CPMSM, CPCS |
| Authorized Official - Phone: | 513-245-3663 |
| Mailing Address - Street 1: | 222 PIEDMONT AVE |
| Mailing Address - Street 2: | SUITE 1200 |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45219-4231 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-475-8014 |
| Mailing Address - Fax: | 513-475-8020 |
| Practice Address - Street 1: | 222 PIEDMONT AVE |
| Practice Address - Street 2: | SUITE 1200 |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45219-4231 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-475-8014 |
| Practice Address - Fax: | 513-475-8020 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | UNIVERISTY OF CINCINNATI PHYSICIANS, INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2008-10-06 |
| Last Update Date: | 2011-08-22 |
| 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 | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | Group - Multi-Specialty |
| No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | 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 | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IN | 200941800A | Medicaid | |
| WV | 3810018244 | Medicaid | |
| OH | 2880324 | Medicaid | |
| KY | 7100096620 | Medicaid | |
| OH | =========31 | Other | BWC |
| IN | M100022953 | Medicare PIN | |
| OH | 9381191 | Medicare PIN | |
| WV | 3810018244 | Medicaid |
