Basic Information
| Provider Information | |||||||||
| NPI: | 1922031020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CINCINNATI HEALTHCARE GROUP PSC, DBA PATIENT FIRST PHYSICIANS GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 334 THOMAS MORE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173464 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 ST. MICHAEL DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLD SPRING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410769999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597814111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | FOLZ | ||||||||
| AuthorizedOfficialFirstName: | KEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8599571080 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CINCINNATI HEALTHCARE GROUP PSC, DBA PATIENT FIRST PHYSICIANS GROUP | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18151 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CD2180 | 01 | KY | RAILROAD MEDICARE | OTHER | CD2175 | 01 | KY | RAILROAD MEDICARE | OTHER | CD2174 | 01 | KY | RAILROAD MEDICARE | OTHER |