MEDICARE: DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	NOT APPLICABLE	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36D00662506	OTHER	OH	CLIA WAIVER

General Provider Information

NPI Number	:	1174565931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	935 STATE ROUTE 28
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-1911
Country	:	US
Telephone Number	:	513-831-5955
Fax Number	:	513-831-5985

Provider Business Practice Location Address
First Line	:	5920 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-6414
Country	:	US
Telephone Number	:	513-741-7044
Fax Number	:	513-741-0718

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL J. AMRHEIN
Credential	:
Telephone Number	:	513-831-5955

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	11/12/2014

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