Healthcare Provider Details

I. General information

NPI: 1811704174
Provider Name (Legal Business Name): MID-WEST JCB INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 LINCOLN AVE
CINCINNATI OH
45206-1349
US

IV. Provider business mailing address

1228 LINCOLN AVE
CINCINNATI OH
45206-1349
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-5094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHEYENNE RILEY
Title or Position: PART OWNER
Credential:
Phone: 513-206-5094