Healthcare Provider Details

I. General information

NPI: 1245091537
Provider Name (Legal Business Name): MR. DARIUS RANDELL BOLLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

11140 HUTCHESON ALY
SPRINGDALE OH
45246-3770
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-1000
  • Fax:
Mailing address:
  • Phone: 214-385-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.529815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: