Provider Demographics
NPI:1881616357
Name:CINCINNATI HEALTH CARE GROUP PSC
Entity type:Organization
Organization Name:CINCINNATI HEALTH CARE GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-957-1080
Mailing Address - Street 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 160B
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-331-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CINCINNATI HEALTH CARE GROUP PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300131261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278324Medicaid
KY490004723OtherRAILROAD MEDICARE
KY36001048Medicaid
KY490004728OtherRAILROAD MEDICARE
OH2278324Medicaid