Healthcare Provider Details

I. General information

NPI: 1093030744
Provider Name (Legal Business Name): TRI COUNTY ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 WAYCROSS RD
CINCINNATI OH
45240
US

IV. Provider business mailing address

752 WAYCROSS RD.
CINCINNATI OH
45240
US

V. Phone/Fax

Practice location:
  • Phone: 513-825-5454
  • Fax: 513-825-5452
Mailing address:
  • Phone: 513-825-5454
  • Fax: 513-825-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA01704
License Number StateOH

VIII. Authorized Official

Name: MR. BRADLEY LEMBERG
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 513-825-5454