Basic Information
| Provider Information | |||||||||
| NPI: | 1336201862 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIN | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2950 ROBERTSON AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452091267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132814400 | ||||||||
| FaxNumber: | 5132814832 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 PHILLIP STONE WAY | ||||||||
| Address2: | |||||||||
| City: | CENTRAL CITY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423301929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707543494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 26925 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 26925 | KY | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.