Healthcare Provider Details

I. General information

NPI: 1023576204
Provider Name (Legal Business Name): ALEXIS HODGE RA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

8737 WUEST RD
CINCINNATI OH
45251-5876
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-4673
  • Fax:
Mailing address:
  • Phone: 513-646-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: