Healthcare Provider Details

I. General information

NPI: 1194723676
Provider Name (Legal Business Name): QUEEN CITY SPORTS MEDICINE AND ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 RED BANK RD
CINCINNATI OH
45227-3429
US

IV. Provider business mailing address

3950 RED BANK RD
CINCINNATI OH
45227-3429
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-1111
  • Fax: 513-561-1241
Mailing address:
  • Phone: 513-561-1111
  • Fax: 513-561-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036587
License Number StateOH

VIII. Authorized Official

Name: JOHN E TURBA
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 513-561-1111