Basic Information
| Provider Information | |||||||||
| NPI: | 1922043918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 BURNET AVENUE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135858074 | ||||||||
| FaxNumber: | 5135858070 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 GOODMAN STREET | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135841000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | HINDS | ||||||||
| AuthorizedOfficialFirstName: | HUGH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP | ||||||||
| AuthorizedOfficialTelephone: | 5135858720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 0590497 | 05 | IA | MEDICAID | 09275371 | 05 | LA | MEDICAID | 911361400 OP | 05 | FL | MEDICAID | 000883726X OP | 05 | GA | MEDICAID | 874661IP | 05 | AZ | MEDICAID | 68931522 IP | 05 | CO | MEDICAID | UNI0003OP | 05 | AL | MEDICAID | XHSP31361 IP | 05 | CA | MEDICAID | 911361400 IP | 05 | FL | MEDICAID | 159639105 | 05 | AR | MEDICAID | 874661 OP | 05 | AZ | MEDICAID | 100369340A | 05 | IN | MEDICAID | 68931522 OP | 05 | CO | MEDICAID | 000883726X IP | 05 | GA | MEDICAID | 200258670 A | 05 | KS | MEDICAID | UNI0003IP | 05 | AL | MEDICAID | XHSP41361 OP | 05 | CA | MEDICAID |