Healthcare Provider Details

I. General information

NPI: 1063855294
Provider Name (Legal Business Name): MT. AUBURN URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 03/13/2024
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 AUBURN AVE SUITE B
CINCINNATI OH
45219-2975
US

IV. Provider business mailing address

2230 AUBURN AVE
CINCINNATI OH
45219-2975
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-0007
  • Fax:
Mailing address:
  • Phone: 513-621-2200
  • Fax: 513-620-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID EUGENE BRADFORD
Title or Position: OWNER
Credential:
Phone: 513-772-9065