Basic Information
| Provider Information | |||||||||
| NPI: | 1093794869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 637783 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452637783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534749 | ||||||||
| FaxNumber: | 5138534740 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 MORNING SUN RD | ||||||||
| Address2: | STE A | ||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450569545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135245330 | ||||||||
| FaxNumber: | 5135245337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 34-005758 | OH | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207P00000X | 34-005758 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208VP0014X | 34-005758 | OH | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00341008 | 01 | OH | RR MEDICARE | OTHER | 200142750 | 05 | IN | MEDICAID | 0931899 | 05 | OH | MEDICAID |