Provider Demographics
NPI:1902284094
Name:ST. ALOYSIUS
Entity Type:Organization
Organization Name:ST. ALOYSIUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:513-242-7600
Mailing Address - Street 1:4721 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6107
Mailing Address - Country:US
Mailing Address - Phone:513-242-7600
Mailing Address - Fax:
Practice Address - Street 1:4721 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6107
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. ALOYSIUS ORPHANAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2475601Medicaid
OH251738OtherCARF
OH251738OtherCARF