Basic Information
| Provider Information | |||||||||
| NPI: | 1821084088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CINCINNATI HEMATOLOGY-ONCOLOGY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 MADISON RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452092276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5135336033 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 MADISON RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452092276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5135336033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KENDRICK | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR/C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 5133214333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | JD,MHA,FACHE,FACMPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 40534 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 32667 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 61751 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 71313 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 86350 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 85883 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 68352 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0827896 | 05 | OH | MEDICAID | 2218193 | 05 | OH | MEDICAID | 2010568 | 05 | OH | MEDICAID | 0156790 | 05 | OH | MEDICAID | 0179462 | 05 | OH | MEDICAID | 0395862 | 05 | OH | MEDICAID |