Provider Demographics
NPI:1881954972
Name:CENTRAL CLINIC FORENSIC SERVICES
Entity type:Organization
Organization Name:CENTRAL CLINIC FORENSIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-558-9015
Mailing Address - Street 1:909 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1305
Mailing Address - Country:US
Mailing Address - Phone:513-352-1342
Mailing Address - Fax:513-352-1345
Practice Address - Street 1:909 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1305
Practice Address - Country:US
Practice Address - Phone:513-352-1342
Practice Address - Fax:513-352-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10126251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH41177OtherCARF
OHMC-21-41Medicaid
OH9201131Medicare PIN