Basic Information
| Provider Information | |||||||||
| NPI: | 1740325554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE PHYSICIANS OF NORTHEAST CINCINNATI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8041 HOSBROOK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138913664 | ||||||||
| FaxNumber: | 5138918925 | ||||||||
| Practice Location | |||||||||
| Address1: | 8041 HOSBROOK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138913664 | ||||||||
| FaxNumber: | 5138918925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | HSIEH | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5138913664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 207R00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0615481 | 05 | OH | MEDICAID |