UNIVERSITY OF CINCINNATI PHYSICIANS, INC.

Provider Demographics

• NPI: 1417108697
• Name: UNIVERSITY OF CINCINNATI PHYSICIANS, INC.
• Entity Type: Organization
• Organization Name: UNIVERSITY OF CINCINNATI PHYSICIANS, INC.
• Other - Org Name: UC PHYSICIANS
• Other - Org Type: Other Name
• Authorized Official - Title/Position: CREDENTIALING MANAGER
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: LISA
• Authorized Official - Middle Name: K
• Authorized Official - Last Name: HUNT
• Authorized Official - Credentials: CPMSM, CPCS
• Authorized Official - Phone: 513-245-3663
• Mailing Address - Street 1: 222 PIEDMONT AVE
• Mailing Address - Street 2: SUITE 1200
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45219-4231
• Mailing Address - Country: US
• Mailing Address - Phone: 513-475-8014
• Mailing Address - Fax: 513-475-8020
• Practice Address - Street 1: 222 PIEDMONT AVE
• Practice Address - Street 2: SUITE 1200
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45219-4231
• Practice Address - Country: US
• Practice Address - Phone: 513-475-8014
• Practice Address - Fax: 513-475-8020
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: UNIVERISTY OF CINCINNATI PHYSICIANS, INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2008-10-06
• Last Update Date: 2011-08-22

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	1223S0112X	Dental Providers	Dentist	Oral and Maxillofacial Surgery	Group - Multi-Specialty
No	204E00000X	Allopathic & Osteopathic Physicians	Oral & Maxillofacial Surgery		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	207ZP0102X	Allopathic & Osteopathic Physicians	Pathology	Anatomic Pathology & Clinical Pathology	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	2085R0001X	Allopathic & Osteopathic Physicians	Radiology	Radiation Oncology	Group - Multi-Specialty
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	367A00000X	Physician Assistants & Advanced Practice Nursing Providers	Advanced Practice Midwife		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	200941800A	Medicaid
WV	3810018244	Medicaid
OH	2880324	Medicaid
KY	7100096620	Medicaid
OH	=========31	Other	BWC
IN	M100022953	Medicare PIN
OH	9381191	Medicare PIN
WV	3810018244	Medicaid