Provider Demographics
NPI:1033209242
Name:EASTERN CINCINNATI INTERNAL MEDICINE SPECIALIST,LLC
Entity Type:Organization
Organization Name:EASTERN CINCINNATI INTERNAL MEDICINE SPECIALIST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEVERYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-528-3300
Mailing Address - Street 1:4044 MCLEAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3323
Mailing Address - Country:US
Mailing Address - Phone:513-528-3300
Mailing Address - Fax:513-528-9023
Practice Address - Street 1:4044 MCLEAN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3323
Practice Address - Country:US
Practice Address - Phone:513-528-3300
Practice Address - Fax:513-528-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty