MEDICARE: UNIVERSITY REHABILITATION, INC.

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
1	2084N0400X	Neurology Physician
2	363A00000X	Physician Assistant	50.000932	OH
3	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	50005942	OTHER	KY	PASSPORT HEALTH PLAN
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235197302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1785
Country	:	US
Telephone Number	:	513-245-3617
Fax Number	:	513-475-7259

Provider Business Practice Location Address
First Line	:	151 W GALBRAITH RD
Second Line	:	DRAKE CENTER
City	:	CINCINNATI
State	:	OH
Zip	:	45216-1015
Country	:	US
Telephone Number	:	513-418-2707
Fax Number	:	513-418-5838

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK J. GODDARD
Credential	:	M.D.
Telephone Number	:	513-558-2919

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	09/24/2010

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