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General NPI Number Information
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NPI Number | 1205772811
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF OHIO INC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 424 WARDS CORNER RD STE 110
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City | LOVELAND
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State | OH
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Zip | 45140-6943
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Country | US
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Telephone | 513-576-5024
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Fax | 513-576-5025
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Provider Business Mailing Address
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Address Line | 424 WARDS CORNER RD STE 200
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City | LOVELAND
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State | OH
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Zip | 45140-6966
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Country | US
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Telephone | 513-576-7700
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Fax | 513-576-1020
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Authorized Official
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Title or Position | DIRECTOR CREDENTIALING
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Name | PATRICIA MIRANDE
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Credential |
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Telephone | 513-707-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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