MEDICARE: PROVIDENCE FERTILITY CARE, LLC

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	261QF0050X	Non-Surgical Family Planning Clinic/Center

General Provider Information

NPI Number	:	1740154483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE FERTILITY CARE, LLC

Provider Business Mailing Address
First Line	:	2723 POWELL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7209
Country	:	US
Telephone Number	:	650-417-1118
Fax Number	:	513-323-6825

Provider Business Practice Location Address
First Line	:	2723 POWELL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7209
Country	:	US
Telephone Number	:	650-417-1118
Fax Number	:	513-323-6825

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JACOB RODEHEFFER
Credential	:
Telephone Number	:	650-417-1118

Provider Enumeration Date	:	10/04/2025
Last Update Date	:	10/04/2025

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