Provider Demographics
NPI:1144229899
Name:GREATER CINCINNATI CARDIOVASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:GREATER CINCINNATI CARDIOVASCULAR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:F. THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JENIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-751-4222
Mailing Address - Street 1:2123 AUBURN AVENUE
Mailing Address - Street 2:SUITE 624
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-751-4222
Mailing Address - Fax:513-751-4353
Practice Address - Street 1:2123 AUBURN AVENUE
Practice Address - Street 2:SUITE 624
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-751-4222
Practice Address - Fax:513-751-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031105207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH845447Medicaid
000000015271OtherANTHEM
KY65919193Medicaid
IN100028740Medicaid
IN202460Medicare PIN
IN100028740Medicaid
KY07731Medicare PIN