=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386730422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINCINNATI PRIMARY CARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2123 AUBURN AVE SUITE 334
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-421-2600
-----------------------------------------------------
Fax | 513-345-6613
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2123 AUBURN AVE SUITE 334
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-421-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INT. MEDICINE PHYSICIAN/PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT JAMES WARDEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 513-421-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01166074
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------