Healthcare Provider Details

I. General information

NPI: 1154462893
Provider Name (Legal Business Name): PHYSICIANS HEALTHSOURCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 WESTBOURNE DR
CINCINNATI OH
45248-5133
US

IV. Provider business mailing address

3328 WESTBOURNE DR
CINCINNATI OH
45248-5133
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-1599
  • Fax: 513-347-2735
Mailing address:
  • Phone: 513-922-1599
  • Fax: 513-347-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN E RUCH
Title or Position: PRESIDENT
Credential: DC
Phone: 513-922-2204