MEDICARE: CHRISTOPHER SIMON

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	367500000X	Certified Registered Nurse Anesthetist	COA 18610 NA	OH
2	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1255797569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SIMON

Provider Business Mailing Address
First Line	:	234 GOODMAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2364
Country	:	US
Telephone Number	:	513-558-4194
Fax Number	:	513-558-0995

Provider Business Practice Location Address
First Line	:	234 GOODMAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2364
Country	:	US
Telephone Number	:	513-558-4194
Fax Number	:	513-558-0995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	02/18/2019

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