Basic Information
| Provider Information | |||||||||
| NPI: | 1003871567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OHVC ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4380 MALSBARY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133664488 | ||||||||
| FaxNumber: | 5133664480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2139 AUBURN AVE | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137218881 | ||||||||
| FaxNumber: | 5132875805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | M ARK | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | COO,VP | ||||||||
| AuthorizedOfficialTelephone: | 5133664488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 65943136 | 05 | KY | MEDICAID | 2510063 | 05 | OH | MEDICAID | 000000350565 | 01 | ANTHEM | OTHER |