Healthcare Provider Details

I. General information

NPI: 1790726644
Provider Name (Legal Business Name): MEDICAL ASSOCIATION OF EASTERN CINCINNATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 OLD STATE ROUTE 74
CINCINNATI OH
45245-1262
US

IV. Provider business mailing address

PO BOX 633094
CINCINNATI OH
45263-3094
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-5800
  • Fax:
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-989-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055795
License Number StateOH

VIII. Authorized Official

Name: THOMAS MEYERS
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 513-752-5800