Healthcare Provider Details

I. General information

NPI: 1033569611
Provider Name (Legal Business Name): THE HEALTH EXPERIENCES PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

IV. Provider business mailing address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

V. Phone/Fax

Practice location:
  • Phone: 513-616-8774
  • Fax:
Mailing address:
  • Phone: 513-783-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35072050
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35076827
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35076827
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number35039200
License Number StateOH

VIII. Authorized Official

Name: MR. CURTIS COOPER
Title or Position: COO
Credential:
Phone: 513-560-4301