Healthcare Provider Details

I. General information

NPI: 1962031807
Provider Name (Legal Business Name): CVP SURGERY CENTER IVY POINTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 IVY GTWY STE 302
CINCINNATI OH
45245-1898
US

IV. Provider business mailing address

4445 LAKE FOREST DR STE 600
BLUE ASH OH
45242-3744
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax:
Mailing address:
  • Phone: 513-569-3741
  • Fax: 513-569-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TERI KNIGHT
Title or Position: SN CREDENTIALS MANAGER
Credential:
Phone: 513-569-3741