MEDICARE: VILLAGE OF GOLF MANOR

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	341600000X	Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590015177	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000221798	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1932135506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF GOLF MANOR

Provider Business Mailing Address
First Line	:	10361 SPARTAN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1220
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-772-4464

Provider Business Practice Location Address
First Line	:	6450 WIEHE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-4216
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-772-4464

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	GREG BALLMAN
Credential	:
Telephone Number	:	513-531-2022

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	11/10/2016

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Directions to “VILLAGE OF GOLF MANOR ” Practice Location

Language	Start Address	Practice Location

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