Provider Demographics
NPI:1598991838
Name:CENTER FOR METABOLIC AND BARIATRIC SURGERY LLC
Entity Type:Organization
Organization Name:CENTER FOR METABOLIC AND BARIATRIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-559-1222
Mailing Address - Street 1:10475 READING RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2563
Mailing Address - Country:US
Mailing Address - Phone:513-559-1222
Mailing Address - Fax:513-559-1235
Practice Address - Street 1:10475 READING RD
Practice Address - Street 2:SUITE 117
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2563
Practice Address - Country:US
Practice Address - Phone:513-559-1222
Practice Address - Fax:513-559-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060979Medicaid
KYCU0856443OtherMEDICARE ID-TYPE UNSPECIFIED
G78361Medicare UPIN