Healthcare Provider Details

I. General information

NPI: 1467098715
Provider Name (Legal Business Name): DIALYSIS ACCESS CENTER OF CINCINNATI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 MONTGOMERY RD STE 140
CINCINNATI OH
45212-2281
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 105
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 513-631-4555
  • Fax: 513-631-5546
Mailing address:
  • Phone: 513-487-5305
  • Fax: 513-487-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTOINE L SAMAHA
Title or Position: PRESIDENT
Credential: MD
Phone: 513-487-5305