Healthcare Provider Details

I. General information

NPI: 1417100710
Provider Name (Legal Business Name): QUEEN CITY EAR, NOSE & THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 MONTGOMERY RD
CINCINNATI OH
45249-2338
US

IV. Provider business mailing address

11135 MONTGOMERY RD
CINCINNATI OH
45249-2338
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-9600
  • Fax: 513-793-4928
Mailing address:
  • Phone: 513-793-9600
  • Fax: 513-793-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA01347
License Number StateOH

VIII. Authorized Official

Name: JEANINE BRAILEY
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMM
Phone: 513-793-9600