Provider Demographics
NPI:1598919904
Name:JENNIFER THIE MD, LLC
Entity Type:Organization
Organization Name:JENNIFER THIE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:THIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-794-1430
Mailing Address - Street 1:4430 CARVER WOODS DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5545
Mailing Address - Country:US
Mailing Address - Phone:513-794-1430
Mailing Address - Fax:513-792-6849
Practice Address - Street 1:4430 CARVER WOODS DR
Practice Address - Street 2:SUITE 125
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5545
Practice Address - Country:US
Practice Address - Phone:513-794-1430
Practice Address - Fax:513-792-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9328201Medicare PIN