Healthcare Provider Details

I. General information

NPI: 1831156561
Provider Name (Legal Business Name): MHSWO HEALTH VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N LIMESTONE ST SUITE 102
SPRINGFIELD OH
45503-2665
US

IV. Provider business mailing address

2200 N LIMESTONE ST SUITE 102
SPRINGFIELD OH
45503-2665
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-5303
  • Fax:
Mailing address:
  • Phone: 937-399-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RENATO SUNTAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 937-328-7000