Provider Demographics
NPI:1497049191
Name:DEACONESS DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:DEACONESS DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-559-2664
Mailing Address - Street 1:311 STRAIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1018
Mailing Address - Country:US
Mailing Address - Phone:513-559-2100
Mailing Address - Fax:513-475-5253
Practice Address - Street 1:311 STRAIGHT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1018
Practice Address - Country:US
Practice Address - Phone:513-559-2100
Practice Address - Fax:513-475-5253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DEACONESS ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10-E-16892-001293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory