Healthcare Provider Details

I. General information

NPI: 1619910809
Provider Name (Legal Business Name): CINCINNATI SPINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 BLUE ASH RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

DEPT L 6084
CINCINNATI OH
45270-6084
US

V. Phone/Fax

Practice location:
  • Phone: 513-792-7445
  • Fax: 513-791-4042
Mailing address:
  • Phone: 513-792-7445
  • Fax: 513-791-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN M ROBERTS
Title or Position: PRESIDENT
Credential: MD
Phone: 513-792-7445