Healthcare Provider Details

I. General information

NPI: 1750869145
Provider Name (Legal Business Name): BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 SOUTH VERITY PARKWAY
MIDDLETOWN OH
45044-5513
US

IV. Provider business mailing address

1620 W. NORTHWEST HWY. SUITE 100
GRAPEVINE TX
76051-3219
US

V. Phone/Fax

Practice location:
  • Phone: 513-217-8900
  • Fax: 513-783-4166
Mailing address:
  • Phone: 817-913-7247
  • Fax: 817-720-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0232000016
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN ROLLER
Title or Position: CEO
Credential:
Phone: 513-464-1460