Provider Demographics
NPI:1538459821
Name:SAMUEL C. DOCENA, MD.,INC
Entity Type:Organization
Organization Name:SAMUEL C. DOCENA, MD.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOCENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-858-6110
Mailing Address - Street 1:1244 NILLES RD STE 10
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2788
Mailing Address - Country:US
Mailing Address - Phone:513-858-6110
Mailing Address - Fax:513-858-2732
Practice Address - Street 1:1244 NILLES RD STE 10
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2788
Practice Address - Country:US
Practice Address - Phone:513-858-6110
Practice Address - Fax:513-858-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0739473Medicaid
OH1376600973OtherNPI
OHSA0884241Medicare PIN
OHB61791Medicare UPIN