Healthcare Provider Details

I. General information

NPI: 1114915634
Provider Name (Legal Business Name): FIDELITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 KETTERING BLVD
MORAINE OH
45439-1924
US

IV. Provider business mailing address

3170 KETTERING BLVD
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6400
  • Fax:
Mailing address:
  • Phone: 937-208-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PAULA THOMPSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 937-208-6461