Provider Demographics
NPI:1881648236
Name:UNIVERSITY DERMATOLOGY CONSULTANTS, INC
Entity Type:Organization
Organization Name:UNIVERSITY DERMATOLOGY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-245-3066
Mailing Address - Street 1:PO BOX 631629
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1629
Mailing Address - Country:US
Mailing Address - Phone:513-245-3060
Mailing Address - Fax:513-245-3070
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 5300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-7630
Practice Address - Fax:513-475-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0781882Medicaid
OHUN9329681Medicare PIN
OHUN9921924Medicare PIN
KY00100Medicare PIN
OHUN9921921Medicare PIN
OHUN9921928Medicare PIN
OHUN9921922Medicare ID - Type Unspecified
OHUN9921929Medicare PIN
OHUN9921923Medicare PIN