Provider Demographics
NPI:1821131194
Name:CRESCENT WOMENS MEDICAL GROUP
Entity Type:Organization
Organization Name:CRESCENT WOMENS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:513-891-0211
Mailing Address - Street 1:10700 MONTGOMERY RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3255
Mailing Address - Country:US
Mailing Address - Phone:513-891-0211
Mailing Address - Fax:513-792-5945
Practice Address - Street 1:10700 MONTGOMERY RD
Practice Address - Street 2:SUITE 311
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3255
Practice Address - Country:US
Practice Address - Phone:513-891-0211
Practice Address - Fax:513-792-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty