Provider Demographics
NPI:1184232167
Name:BROOMFIELD, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BROOMFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1745
Mailing Address - Country:US
Mailing Address - Phone:513-621-1117
Mailing Address - Fax:
Practice Address - Street 1:2347 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-621-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator