=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306928072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLERMONT COUNTY COMMUNITY SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 03/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 HOSPITAL DR
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-2277
-----------------------------------------------------
Fax | 513-735-8839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 HOSPITAL DR
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-2277
-----------------------------------------------------
Fax | 513-735-8839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | SHEEMA FAROOQUI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 513-732-2277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------