Provider Demographics
NPI:1164833604
Name:UNIVERSITY OF CINCINNATI MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CINCINNATI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:423-914-3425
Mailing Address - Street 1:UNIVERSITY OF CINCINNATI PHYSICAL MEDICINE
Mailing Address - Street 2:PO BOX 670530
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0530
Mailing Address - Country:US
Mailing Address - Phone:513-558-2919
Mailing Address - Fax:513-558-4458
Practice Address - Street 1:260 STETSON STREET
Practice Address - Street 2:SUITE 5200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-558-2919
Practice Address - Fax:513-558-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital