Provider Demographics
NPI:1871727743
Name:LIFECENTER ORGAN DONOR NETWORK
Entity type:Organization
Organization Name:LIFECENTER ORGAN DONOR NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-558-5555
Mailing Address - Street 1:2925 VERNON PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-558-5555
Mailing Address - Fax:513-558-5556
Practice Address - Street 1:2925 VERNON PL
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2425
Practice Address - Country:US
Practice Address - Phone:513-558-5555
Practice Address - Fax:513-558-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335U00000XSuppliersOrgan Procurement Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-P003Medicare PIN