Healthcare Provider Details

I. General information

NPI: 1881648236
Provider Name (Legal Business Name): UNIVERSITY DERMATOLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE SUITE 5300
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

PO BOX 631629
CINCINNATI OH
45263-1629
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7630
  • Fax: 513-475-7636
Mailing address:
  • Phone: 513-245-3060
  • Fax: 513-245-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RENA ALEX
Title or Position: DIRECTOR OF BILLING OPERATIONS
Credential:
Phone: 513-245-3066