Provider Demographics
NPI:1902819154
Name:CITY OF CINCINNATI
Entity Type:Organization
Organization Name:CITY OF CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASERU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MPH
Authorized Official - Phone:513-357-7280
Mailing Address - Street 1:3101 BURNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:513-357-7396
Practice Address - Street 1:3917 SPRING GROVE AVE
Practice Address - Street 2:NORTHSIDE HEALTH CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-3302
Practice Address - Country:US
Practice Address - Phone:513-357-7600
Practice Address - Fax:513-352-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X, 251K00000X, 261QP2300X, 292200000X
OH36D0894909291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No291U00000XLaboratoriesClinical Medical Laboratory
No292200000XLaboratoriesDental Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184581Medicaid
OH9281061Medicare PIN