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General NPI Number Information
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NPI Number | 1912937608
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Entity Type | Organization
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Legal Business Name | TRICOUNTY GYNOB LLC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 3035 HAMILTON MASON ROAD, SUITE 106
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City | HAMILTON
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State | OH
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Zip | 45011-5307
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Country | US
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Telephone | 513-867-0111
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Fax | 513-894-3625
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Provider Business Mailing Address
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Address Line | PO BOX 635035
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City | CINCINNATI
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State | OH
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Zip | 45263
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Country | US
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Telephone | 513-867-0111
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Fax | 513-894-3625
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Authorized Official
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Title or Position | BILLING / CREDENTIAL MANAGER
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Name | VICKI HUMPHREYS
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Credential |
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Telephone | 513-893-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35043818
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License Number State | OH
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