Provider Demographics
NPI:1740213917
Name:CINCINNATI HEALTHCARE GROUP PSC, DBA PATIENT FIRST PHYSICIANS GROUP
Entity Type:Organization
Organization Name:CINCINNATI HEALTHCARE GROUP PSC, DBA PATIENT FIRST PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-957-1080
Mailing Address - Street 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:859-431-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CINCINNATI HEALTHCARE GROUP PSC, DBA PATIENT FIRST PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23828207Q00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCD2174OtherRAILROAD MEDICARE
KYCD2179OtherRAILROAD MEDICARE
KYCD2176OtherRAILROAD MEDICARE
KY3876Medicare PIN