Provider Demographics
NPI:1891089983
Name:DR. JERRY H. MCDANIEL, MD, INC
Entity Type:Organization
Organization Name:DR. JERRY H. MCDANIEL, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-851-6500
Mailing Address - Street 1:375 GLENSPRINGS DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2316
Mailing Address - Country:US
Mailing Address - Phone:513-851-6500
Mailing Address - Fax:513-851-0265
Practice Address - Street 1:375 GLENSPRINGS DR
Practice Address - Street 2:SUITE 410
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2316
Practice Address - Country:US
Practice Address - Phone:513-851-6500
Practice Address - Fax:513-851-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047141261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489921Medicaid