Healthcare Provider Details

I. General information

NPI: 1194150714
Provider Name (Legal Business Name): LIVING WELL OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 MONTGOMERY RD STE 150
CINCINNATI OH
45242-4460
US

IV. Provider business mailing address

10615 MONTGOMERY RD STE 150
CINCINNATI OH
45242-4460
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-9355
  • Fax: 859-223-0642
Mailing address:
  • Phone: 513-984-9355
  • Fax: 859-223-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN HITCHCOCK
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 513-475-3180