Provider Demographics
NPI:1578039632
Name:GAINES, SAMUEL QUINCY (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:QUINCY
Last Name:GAINES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8459 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-3938
Mailing Address - Country:US
Mailing Address - Phone:513-815-3851
Mailing Address - Fax:513-834-8944
Practice Address - Street 1:8459 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3938
Practice Address - Country:US
Practice Address - Phone:513-815-3851
Practice Address - Fax:859-572-2326
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant