Provider Demographics
NPI:1932527959
Name:CINCINNATI CRYOSPA
Entity Type:Organization
Organization Name:CINCINNATI CRYOSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-380-4800
Mailing Address - Street 1:900 ADAMS CROSSING STE B
Mailing Address - Street 2:UNIT #1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1666
Mailing Address - Country:US
Mailing Address - Phone:513-621-2796
Mailing Address - Fax:
Practice Address - Street 1:900 ADAMS CROSSING STE B
Practice Address - Street 2:UNIT #1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1666
Practice Address - Country:US
Practice Address - Phone:513-621-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service