Basic Information
| Provider Information | |||||||||
| NPI: | 1003993346 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RODNEY E. VIVIAN MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 5 MILE RD | ||||||||
| Address2: | 240 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452302163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 5 MILE RD | ||||||||
| Address2: | 240 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452302163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | DRIGGETT | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5132323070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 196047000 | 01 | MAGELLAN | OTHER |