Provider Demographics
NPI:1669692687
Name:PRIMARY CARE OF CINCINNATI INC
Entity type:Organization
Organization Name:PRIMARY CARE OF CINCINNATI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSINBOWALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-961-1100
Mailing Address - Street 1:318 EAST UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2431
Mailing Address - Country:US
Mailing Address - Phone:513-961-1100
Mailing Address - Fax:513-961-7156
Practice Address - Street 1:318 EAST UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2431
Practice Address - Country:US
Practice Address - Phone:513-961-1100
Practice Address - Fax:513-961-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962203Medicaid
A81752Medicare UPIN
OH9266821Medicare ID - Type Unspecified