Provider Demographics
NPI:1740325554
Name:PRIMARY CARE PHYSICIANS OF NORTHEAST CINCINNATI INC
Entity type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF NORTHEAST CINCINNATI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-891-3664
Mailing Address - Street 1:8041 HOSBROOK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2989
Mailing Address - Country:US
Mailing Address - Phone:513-891-3664
Mailing Address - Fax:513-891-8925
Practice Address - Street 1:8041 HOSBROOK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2989
Practice Address - Country:US
Practice Address - Phone:513-891-3664
Practice Address - Fax:513-891-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0615481Medicaid
OH0615481Medicaid
PR0570451Medicare ID - Type Unspecified
OHA15190Medicare UPIN
HS0517433Medicare ID - Type Unspecified
A16151Medicare UPIN