Provider Demographics
NPI:1801829130
Name:CINCINNATI HEALTH CARE GROUP PSC
Entity Type:Organization
Organization Name:CINCINNATI HEALTH CARE GROUP PSC
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 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3290
Practice Address - Country:US
Practice Address - Phone:859-957-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CINCINNATI HEALTHCARE GROUP PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCD2174OtherRAILROAD MEDICARE
KYCD2176OtherRAILROAD MEDICARE
KYCD2181OtherRAILROAD MEDICARE
KYCD2178OtherRAILROAD MEDICARE
KY3875Medicare PIN