Healthcare Provider Details

I. General information

NPI: 1801829130
Provider Name (Legal Business Name): CINCINNATI HEALTH CARE GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDRIA PIKE SUITE 300
SOUTHGATE KY
41071-3290
US

IV. Provider business mailing address

334 THOMAS MORE PKWY SUITE 200
CRESTVIEW HILLS KY
41017-3464
US

V. Phone/Fax

Practice location:
  • Phone: 859-957-1080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27527
License Number StateKY

VIII. Authorized Official

Name: MR. KEN FOLZ
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 859-957-1080