MEDICARE: OHIO VALLEY HEMORRHOID CENTER

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	208D00000X	General Practice Physician	35046494	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000579583	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1831357383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO VALLEY HEMORRHOID CENTER

Provider Business Mailing Address
First Line	:	3460 DAVIS LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2402
Country	:	US
Telephone Number	:	513-482-9291
Fax Number	:	513-351-1547

Provider Business Practice Location Address
First Line	:	1515 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6703
Country	:	US
Telephone Number	:	513-482-9291
Fax Number	:	513-351-1547

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	KEEVIN R DAVIS
Credential	:	M.D.
Telephone Number	:	513-482-9291

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	06/19/2009

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