Basic Information
| Provider Information | |||||||||
| NPI: | 1619997459 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOES/PAULDING, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 638120 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452638120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198245063 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Practice Location | |||||||||
| Address1: | 5800 MONROE ST | ||||||||
| Address2: | BUILDING E #4 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198243433 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARCELO | ||||||||
| AuthorizedOfficialFirstName: | MANNY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINSTRATIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4198245063 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NOES/PAULDING, LTD | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.