Provider Demographics
NPI:1790726644
Name:MEDICAL ASSOCIATION OF EASTERN CINCINNATI
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATION OF EASTERN CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-752-5800
Mailing Address - Street 1:PO BOX 633094
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3094
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:314-989-5797
Practice Address - Street 1:796 OLD STATE ROUTE 74
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1262
Practice Address - Country:US
Practice Address - Phone:513-752-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2282426Medicaid
OH9320501Medicare ID - Type UnspecifiedMEDICARE PROVIDER GRP #