| K&g Dedicated Long-term Care Associates Llc | |
|
2155 Dana Ave Cincinnati OH 45207-1340 | |
| (513) 843-7716 | |
| (513) 718-3223 |
| Full Name | K&g Dedicated Long-term Care Associates Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 2155 Dana Ave, Cincinnati, Ohio |
| Authorized Official Name and Position | Kenrick Richardson (PRESIDENT/MD) |
| Authorized Official Contact | 5138437632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| K&g Dedicated Long-term Care Associates Llc 71 Vista Ridge Dr South Lebanon OH 45065-8755 Ph: (513) 843-7716 | K&g Dedicated Long-term Care Associates Llc 2155 Dana Ave Cincinnati OH 45207-1340 Ph: (513) 843-7716 |
| NPI Number | 1730735069 |
|---|---|
| Provider Enumeration Date | 08/13/2019 |
| Last Update Date | 03/14/2023 |
| Medicare PECOS PAC ID | 0345572244 |
|---|---|
| Medicare Enrollment ID | O20191025001644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730735069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Kenrick Sylvester Richardson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295736049 PECOS PAC ID: 9436140027 Enrollment ID: I20040521000755 |
| Provider Name | Julie N Pavach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194043141 PECOS PAC ID: 6507999000 Enrollment ID: I20100804000859 |
| Provider Name | Janet Hollmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487041356 PECOS PAC ID: 7810205333 Enrollment ID: I20151002001938 |
| Provider Name | Deana Roper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093243305 PECOS PAC ID: 5597033415 Enrollment ID: I20170619001444 |
| Provider Name | Paul Evens Gregoire Charles |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1578974556 PECOS PAC ID: 3971814658 Enrollment ID: I20170815004393 |
| Provider Name | Joseph B Agyepong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164817003 PECOS PAC ID: 7315247681 Enrollment ID: I20180515002057 |
| Provider Name | Truong Quang Bui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104211556 PECOS PAC ID: 1951603174 Enrollment ID: I20190722000608 |
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