Healthcare Provider Details
I. General information
NPI: 1962325068
Provider Name (Legal Business Name): A1 RENEW
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6725 MIAMI AVE STE 201
CINCINNATI OH
45243-3158
US
IV. Provider business mailing address
6725 MIAMI AVE STE 201
CINCINNATI OH
45243-3158
US
V. Phone/Fax
- Phone: 513-271-7639
- Fax:
- Phone: 513-271-7639
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
BRIAN
ERIC
BRAXTON
Title or Position: PRESIDENT
Credential: MD
Phone: 513-271-7639