Provider Demographics
NPI:1972576957
Name:KENNETH G. AMEND, M.D., INC.
Entity type:Organization
Organization Name:KENNETH G. AMEND, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-923-3900
Mailing Address - Street 1:5939 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6413
Mailing Address - Country:US
Mailing Address - Phone:513-923-3900
Mailing Address - Fax:513-923-3012
Practice Address - Street 1:5939 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6413
Practice Address - Country:US
Practice Address - Phone:513-923-3900
Practice Address - Fax:513-923-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903811Medicaid
OH0903811Medicaid