Healthcare Provider Details

I. General information

NPI: 1972097707
Provider Name (Legal Business Name): EQUITAS HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E LONG ST
COLUMBUS OH
43203-1846
US

IV. Provider business mailing address

1105 SCHROCK RD STE 400
COLUMBUS OH
43229-1174
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-6700
  • Fax: 833-222-8164
Mailing address:
  • Phone: 833-378-4827
  • Fax: 833-222-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KAREN SHEPHERD
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 833-378-4827