Provider Demographics
NPI:1124028162
Name:PERIOPERATIVE MEDICAL CONSUTANTS INC
Entity Type:Organization
Organization Name:PERIOPERATIVE MEDICAL CONSUTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-672-4128
Mailing Address - Street 1:200 NORTHLAND BLVD FL 1SR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3604
Mailing Address - Country:US
Mailing Address - Phone:513-672-4128
Mailing Address - Fax:513-672-4479
Practice Address - Street 1:3000 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5335
Practice Address - Country:US
Practice Address - Phone:513-672-4128
Practice Address - Fax:513-672-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2628222Medicaid
OH2006171Medicaid
OH2202888Medicaid
OH2006180Medicaid
OH2056064Medicaid
KY65943326Medicaid
OH2060148Medicaid
OHPE9288481Medicare ID - Type Unspecified
OH2202888Medicaid
OH2628222Medicaid
OHPE9288483Medicare PIN
OHPE9288484Medicare PIN