Basic Information
| Provider Information | |||||||||
| NPI: | 1083667497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARING SPEECH AND DEAF CENTER OF GREATER CINCINNATI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2825 BURNET AVENUE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132210527 | ||||||||
| FaxNumber: | 5132218014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 BURNET AVENUE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132210527 | ||||||||
| FaxNumber: | 5132218014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOOTHE | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5132210527 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 237600000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 261QH0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
ID Information
| ID | Type | State | Issuer | Description | 9324991 | 01 | OH | OHIO MEDICARE PART B | OTHER | 0408951 | 05 | OH | MEDICAID | DG1062 | 01 | OH | RR MEDICARE | OTHER |