Provider Demographics
NPI:1619974987
Name:HACKWORTH, JOE NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:NATHAN
Last Name:HACKWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 EDWARDS RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1672
Mailing Address - Country:US
Mailing Address - Phone:513-985-0741
Mailing Address - Fax:513-979-2830
Practice Address - Street 1:4101 EDWARDS RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1672
Practice Address - Country:US
Practice Address - Phone:513-985-0741
Practice Address - Fax:513-979-2830
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-9624207RC0000X
OH35039624207RI0011X
KY33001207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0369006OtherMEDICARE
060037112OtherRR MEDICARE
OHP00884967OtherRR MEDICARE
KY0562606OtherMEDICARE
KY64739444Medicaid
OH611300608052OtherCARESOURCE
OH0317857Medicaid
KY0369106OtherMEDICARE
KY0562606Medicare PIN
OH611300608052OtherCARESOURCE
KY0369106OtherMEDICARE
D32009Medicare UPIN
OH0423405Medicare PIN
OH0317857Medicaid
KYP400020363Medicare PIN
OH0423404Medicare PIN