Provider Demographics
NPI:1578501193
Name:ADVANCED BARIATRIC CENTERS
Entity type:Organization
Organization Name:ADVANCED BARIATRIC CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMTIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-426-7000
Mailing Address - Street 1:415 GREENWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5302
Mailing Address - Country:US
Mailing Address - Phone:513-557-3507
Mailing Address - Fax:513-557-3506
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-426-7000
Practice Address - Fax:859-426-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268148Medicaid
KYC69334Medicare UPIN
OH2268148Medicaid