MEDICARE: CINCINNATI UROGYNECOLOGY ASSOCIATES

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	174400000X	Specialist

General Provider Information

NPI Number	:	1760782429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINCINNATI UROGYNECOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 636406
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-463-4300
Fax Number	:	513-463-4310

Provider Business Practice Location Address
First Line	:	7759 UNIVERSITY DR
Second Line	:	SUITE D
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6578
Country	:	US
Telephone Number	:	513-463-4300
Fax Number	:	513-463-4310

Authorized Official
Title or Position	:	SR VP CORP COUNCIL
Name	:	DONNA S NIENABER
Credential	:
Telephone Number	:	513-569-6062

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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