=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952178832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRI-MED EXAMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 OFFICE PARK DR STE A
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45013-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-330-5238
-----------------------------------------------------
Fax | 513-880-0540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 376
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45056-0376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-690-2078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | JENNIFER ROBB
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 513-593-4328
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------