Provider Demographics
NPI: | 1891065256 |
---|---|
Name: | CHRIST HOSPITAL MEDICAL SPECIALISTS II, LLC |
Entity Type: | Organization |
Organization Name: | CHRIST HOSPITAL MEDICAL SPECIALISTS II, LLC |
Other - Org Name: | CINCINNATI HEMATOLOGY ONCOLOGY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER OF REVENUE CYCLE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KAREN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FAIRBANK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 513-263-8535 |
Mailing Address - Street 1: | 237 WILLIAM HOWARD TAFT RD |
Mailing Address - Street 2: | 2ND FLOOR, CBO2-3; ATTN: PROVIDER ENROLLMENT |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45219-2610 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-263-8551 |
Mailing Address - Fax: | 513-366-4480 |
Practice Address - Street 1: | 4460 RED BANK RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45227-2172 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-321-4333 |
Practice Address - Fax: | 513-533-6033 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-03 |
Last Update Date: | 2017-09-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207RH0003X, 207RX0202X, 2085R0001X, 363A00000X, 363AM0700X, 363AS0400X, 363L00000X, 363LA2100X, 363LA2200X, 363LF0000X, 363L00000X, 363LA2200X, 363LF0000X | ||
OH | 85883 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |