Provider Demographics
NPI:1629008628
Name:VESTER, SAMUEL RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RUSSELL
Last Name:VESTER
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 1:4750 E GALBRAITH RD STE 215
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6706
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-345-2606
Practice Address - Street 1:3188 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2369
Practice Address - Country:US
Practice Address - Phone:513-475-8787
Practice Address - Fax:513-929-7239
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061926V208600000X, 208G00000X
OH35.061926208G00000X
KY29644208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
310804060033OtherCARESOURCE
1820066OtherUNITED HEALTHCARE
8330OtherKY BCBS
OH0840862Medicaid
KY64296445Medicaid
000000005014OtherANTHEM
61926OtherCHOICE CARE/HUMANA
IN200058070BMedicaid
OH0840862Medicaid
KY64296445Medicaid
KY0677802Medicare PIN
780001125Medicare PIN
IN200058070BMedicaid
000000005014OtherANTHEM
A58256Medicare UPIN