Provider Demographics
NPI:1447362843
Name:CINCINNATI MED LAB
Entity type:Organization
Organization Name:CINCINNATI MED LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANZOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-702-2316
Mailing Address - Street 1:5437 DENGAIL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4704
Mailing Address - Country:US
Mailing Address - Phone:513-702-2316
Mailing Address - Fax:
Practice Address - Street 1:5437 DENGAIL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4704
Practice Address - Country:US
Practice Address - Phone:513-702-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000013336OtherANTHEM
OH0475785Medicaid
OH3500311OtherUHC
OH000000013336OtherANTHEM