MEDICARE: PHYSICIANS HEALTHSOURCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	225100000X	Physical Therapist
4	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154462893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS HEALTHSOURCE INC

Provider Business Mailing Address
First Line	:	3328 WESTBOURNE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-5133
Country	:	US
Telephone Number	:	513-922-1599
Fax Number	:	513-347-2735

Provider Business Practice Location Address
First Line	:	3328 WESTBOURNE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-5133
Country	:	US
Telephone Number	:	513-922-1599
Fax Number	:	513-347-2735

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN E RUCH
Credential	:	DC
Telephone Number	:	513-922-2204

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/13/2016

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Directions to “PHYSICIANS HEALTHSOURCE INC ” Practice Location

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