Healthcare Provider Details

I. General information

NPI: 1437072501
Provider Name (Legal Business Name): HEALTHSOURCE OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 NORTH HIGH STREET
MOWRYSTOWN OH
45155-2001
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 937-306-1000
  • Fax: 937-306-1001
Mailing address:
  • Phone: 513-576-4041
  • Fax: 513-576-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PRATHER II, MD
Title or Position: CEO
Credential: MD
Phone: 513-707-4041