Provider Demographics
NPI:1205090347
Name:OHIO PHLEBOLOGY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:OHIO PHLEBOLOGY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-844-5921
Mailing Address - Street 1:8044 MONTGOMERY RD STE 525
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2925
Mailing Address - Country:US
Mailing Address - Phone:513-793-7999
Mailing Address - Fax:513-793-7991
Practice Address - Street 1:8044 MONTGOMERY RD
Practice Address - Street 2:SUITE 525
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2919
Practice Address - Country:US
Practice Address - Phone:630-725-2768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2086S0129X, 2085R0204X, 208600000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH9379701Medicare PIN