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General NPI Number Information
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NPI Number | 1548297807
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Entity Type | Organization
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Legal Business Name | QUEEN CITY GENERAL & VASCULAR SURGEONS GROUP LTD
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 7502 STATE RD STE. 1180
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City | CINCINNATI
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State | OH
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Zip | 45255-2800
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Country | US
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Telephone | 513-232-8181
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Fax | 513-624-2964
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Provider Business Mailing Address
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Address Line | 1270 SOLUTIONS CENTER PO BOX 771270
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City | CHICAGO
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State | IL
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Zip | 60677-1002
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Country | US
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Telephone | 513-542-6898
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Fax | 513-542-7972
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. PEGGY ERTEL
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Credential |
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Telephone | 513-232-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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