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NPI Code Detail

MEDICARE: JEREMY K BISHOP

MEDICARE: JEREMY K BISHOP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorC.0501192OH
2171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1205003555
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY K BISHOP
Provider Business Mailing Address
First Line : 1640 NW WASHINGTON BLVD
Second Line :
City : HAMILTON
State : OH
Zip : 45013-1753
Country : US
Telephone Number : 513-255-2903
Fax Number :
Provider Business Practice Location Address
First Line : 110 SOUTH COLLEGE AVE
Second Line :
City : OXFORD
State : OH
Zip : 45056-1738
Country : US
Telephone Number : 513-523-4149
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2008
Last Update Date : 01/07/2010

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