Provider Demographics
NPI:1275589251
Name:CEDAR VALLEY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CEDAR VALLEY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-544-8989
Mailing Address - Street 1:PO BOX 634023
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:126 N CROSS ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1209
Practice Address - Country:US
Practice Address - Phone:937-544-8989
Practice Address - Fax:937-544-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942609Medicaid
OHDC2504OtherRAILROAD MEDICARE
OH2445232Medicaid
OH9338041Medicare PIN
OH7871Medicare PIN