Healthcare Provider Details

I. General information

NPI: 1851103329
Provider Name (Legal Business Name): MOMENTUM PROVIDER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 BROWNS RUN RD
MIDDLETOWN OH
45042-9483
US

IV. Provider business mailing address

7460 BROWNS RUN RD
MIDDLETOWN OH
45042-9483
US

V. Phone/Fax

Practice location:
  • Phone: 513-960-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SUAN J COX
Title or Position: OWNER
Credential:
Phone: 513-968-2000