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NPI Code Detail

MEDICARE: HEALTHSOURCE OF OHIO, INC.

MEDICARE: HEALTHSOURCE OF OHIO, INC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CH7473OTHEROHRAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1417992330
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHSOURCE OF OHIO, INC.
Provider Business Mailing Address
First Line : 424 WARDS CORNER RD STE 200
Second Line :
City : LOVELAND
State : OH
Zip : 45140-6966
Country : US
Telephone Number : 513-707-4041
Fax Number : 513-576-1020
Provider Business Practice Location Address
First Line : 150 HEALTH PARTNERS CIR
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-8610
Country : US
Telephone Number : 937-444-2514
Fax Number : 937-444-4818
Authorized Official
Title or Position : CEO
Name : JOSEPH W PRATHER II
Credential : MD
Telephone Number : 513-707-4041
Provider Enumeration Date : 06/17/2006
Last Update Date : 09/18/2024

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Directions to “HEALTHSOURCE OF OHIO, INC. ” Practice Location

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