Provider Demographics
NPI:1114324589
Name:HEALTH RESOURCE CENTER OF CINCINNATI, INC.
Entity Type:Organization
Organization Name:HEALTH RESOURCE CENTER OF CINCINNATI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-357-4602
Mailing Address - Street 1:2347 VINE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1745
Mailing Address - Country:US
Mailing Address - Phone:513-357-4602
Mailing Address - Fax:513-621-2350
Practice Address - Street 1:2347 VINE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-357-4602
Practice Address - Fax:513-621-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN225695163W00000X
OH35.037521207Q00000X
OHRN218224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH345080Medicare PIN