Provider Demographics
NPI:1467098715
Name:DIALYSIS ACCESS CENTER OF CINCINNATI, INC.
Entity Type:Organization
Organization Name:DIALYSIS ACCESS CENTER OF CINCINNATI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-487-5305
Mailing Address - Street 1:4600 MONTGOMERY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:513-487-5305
Mailing Address - Fax:513-487-5317
Practice Address - Street 1:4805 MONTGOMERY RD STE 140
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2281
Practice Address - Country:US
Practice Address - Phone:513-631-4555
Practice Address - Fax:513-631-5546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIALYSIS ACCESS CENTER OF CINCINNATI, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty