Provider Demographics
NPI:1588055636
Name:ANNE REDDINGTON DO LLC
Entity type:Organization
Organization Name:ANNE REDDINGTON DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:REDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-949-4567
Mailing Address - Street 1:PO BOX 638786
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8786
Mailing Address - Country:US
Mailing Address - Phone:937-949-4567
Mailing Address - Fax:937-350-6477
Practice Address - Street 1:707 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3462
Practice Address - Country:US
Practice Address - Phone:937-949-4567
Practice Address - Fax:937-350-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118776Medicaid
OHH264060Medicare PIN
OH0118776Medicaid