Provider Demographics
NPI:1992472013
Name:BUTTS, JOSEPH JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BUTTS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 MEADOWIND CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4607
Mailing Address - Country:US
Mailing Address - Phone:513-470-6940
Mailing Address - Fax:
Practice Address - Street 1:1093 MEADOWIND CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4607
Practice Address - Country:US
Practice Address - Phone:513-470-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8717181773Medicaid