Healthcare Provider Details

I. General information

NPI: 1821050824
Provider Name (Legal Business Name): BN NORTHEAST CARDIAC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 MONTGOMERY ROAD SUITE G 103
CINCINNATI OH
45242-4487
US

IV. Provider business mailing address

10506 MONTGOMERY ROAD SUITE G 103
CINCINNATI OH
45242-4487
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-5120
  • Fax: 513-865-5121
Mailing address:
  • Phone: 513-865-5120
  • Fax: 513-865-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberHCF #1156 IC
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK JOHN SHEA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 513-865-5120