Healthcare Provider Details

I. General information

NPI: 1699227959
Provider Name (Legal Business Name): CINCINNATI OBSERVATION AND PROFESSIONAL STAFFING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

10506 MONTGOMERY RD SUITE 209
CINCINNATI OH
45242-4487
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax:
Mailing address:
  • Phone: 513-865-9040
  • Fax: 513-865-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number201628103222
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL BAIN
Title or Position: OWNER
Credential: MD
Phone: 513-865-9040