Provider Demographics
NPI:1437691177
Name:FRESENIUS VASCULAR CARE CINCINNATI ASC LLC
Entity Type:Organization
Organization Name:FRESENIUS VASCULAR CARE CINCINNATI ASC LLC
Other - Org Name:AZURA SURGERY CENTER CINCINNATI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-644-8900
Mailing Address - Street 1:PO BOX 419590
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9590
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:4600 SMITH RD
Practice Address - Street 2:SUITE A4
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2793
Practice Address - Country:US
Practice Address - Phone:513-351-2494
Practice Address - Fax:513-351-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100574620Medicaid
OH0273202Medicaid