Provider Demographics
NPI:1518938471
Name:UNIVERSITY OF CINCINNATI SURGEONS-TRAUMA, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF CINCINNATI SURGEONS-TRAUMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:TALIESIN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-245-3300
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:STE. 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3300
Mailing Address - Fax:513-245-3340
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:ML 0558
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-245-3300
Practice Address - Fax:513-245-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493798Medicaid
OH2493798Medicaid