MEDICARE: DIALYSIS ACCESS CENTER OF CINCINNATI, 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	208600000X	Surgery Physician
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1467098715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS ACCESS CENTER OF CINCINNATI, INC.

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 105
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	513-487-5305
Fax Number	:	513-487-5317

Provider Business Practice Location Address
First Line	:	4805 MONTGOMERY RD STE 140
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2281
Country	:	US
Telephone Number	:	513-631-4555
Fax Number	:	513-631-5546

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTOINE L SAMAHA
Credential	:	MD
Telephone Number	:	513-487-5305

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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