Provider Demographics
NPI:1831357383
Name:OHIO VALLEY HEMORRHOID CENTER
Entity type:Organization
Organization Name:OHIO VALLEY HEMORRHOID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-482-9291
Mailing Address - Street 1:3460 DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2402
Mailing Address - Country:US
Mailing Address - Phone:513-482-9291
Mailing Address - Fax:513-351-1547
Practice Address - Street 1:1515 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6703
Practice Address - Country:US
Practice Address - Phone:513-482-9291
Practice Address - Fax:513-351-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000579583OtherANTHEM
OHOH9380141Medicare PIN