Provider Demographics
NPI:1629275177
Name:FULL SPECTRUM HEALTH CENTER LLC
Entity Type:Organization
Organization Name:FULL SPECTRUM HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-221-2111
Mailing Address - Street 1:3836 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1535
Mailing Address - Country:US
Mailing Address - Phone:513-221-2111
Mailing Address - Fax:513-221-0111
Practice Address - Street 1:3836 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1535
Practice Address - Country:US
Practice Address - Phone:513-221-2111
Practice Address - Fax:513-221-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071837S174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DH1068Medicare PIN
OHG44506Medicare UPIN
OH9343691Medicare PIN