Healthcare Provider Details

I. General information

NPI: 1639414063
Provider Name (Legal Business Name): FIDELITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8385 N MAIN ST
DAYTON OH
45415-1602
US

IV. Provider business mailing address

3832 KETTERING BLVD
MORAINE OH
45439-2017
US

V. Phone/Fax

Practice location:
  • Phone: 937-898-1566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PAULA THOMPSON
Title or Position: PRESIDENT & CFO
Credential:
Phone: 937-208-6461