Healthcare Provider Details

I. General information

NPI: 1205772811
Provider Name (Legal Business Name): HEALTHSOURCE OF OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 WARDS CORNER RD STE 110
LOVELAND OH
45140-6943
US

IV. Provider business mailing address

424 WARDS CORNER RD STE 200
LOVELAND OH
45140-6966
US

V. Phone/Fax

Practice location:
  • Phone: 513-576-5024
  • Fax: 513-576-5025
Mailing address:
  • Phone: 513-576-7700
  • Fax: 513-576-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MIRANDE
Title or Position: DIRECTOR CREDENTIALING
Credential:
Phone: 513-707-4041