Provider Demographics
NPI:1457468860
Name:CITY OF CINCINNATI
Entity Type:Organization
Organization Name:CITY OF CINCINNATI
Other - Org Name:CITY OF CINCINNATI - ELM ST HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASERU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:513-357-7280
Mailing Address - Street 1:3101 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:513-357-7396
Practice Address - Street 1:1525 ELM ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6957
Practice Address - Country:US
Practice Address - Phone:513-352-3092
Practice Address - Fax:513-352-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0836653Medicaid
OH361803Medicare Oscar/Certification