Provider Demographics
NPI:1952459026
Name:COMPREHENSIVE BREAST CENTER, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE BREAST CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-933-0222
Mailing Address - Street 1:PO BOX 712737
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-2737
Mailing Address - Country:US
Mailing Address - Phone:513-421-3504
Mailing Address - Fax:513-231-7055
Practice Address - Street 1:1080 BEECHER XING N
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4557
Practice Address - Country:US
Practice Address - Phone:614-933-0222
Practice Address - Fax:614-573-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3400614174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713184Medicaid
OH4046712OtherINDIVIDUAL MCR
OHP00383995OtherRAILROAD MCR
OH4046712OtherINDIVIDUAL MCR