Provider Demographics
NPI:1114997236
Name:CHRIST HOSPITAL EDUCATION AND CLINICAL RESEARCH FUND
Entity Type:Organization
Organization Name:CHRIST HOSPITAL EDUCATION AND CLINICAL RESEARCH FUND
Other - Org Name:EDUCATION AND CLINICAL RESEARCH FUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-585-2960
Mailing Address - Street 1:2139 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-2960
Mailing Address - Fax:513-585-4094
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-2960
Practice Address - Fax:513-585-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0924889Medicaid
OHCH9216252Medicare ID - Type Unspecified