Provider Demographics
NPI:1013256817
Name:ISCHEMIA CARE, LLC
Entity Type:Organization
Organization Name:ISCHEMIA CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:JUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-827-9106
Mailing Address - Street 1:347 S COLLEGE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2217
Mailing Address - Country:US
Mailing Address - Phone:513-827-9106
Mailing Address - Fax:
Practice Address - Street 1:6960 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3025
Practice Address - Country:US
Practice Address - Phone:513-827-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2039784291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory