=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467150086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUITAS HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 W EXCHANGE ST
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44302-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-378-4827
-----------------------------------------------------
Fax | 800-222-8164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 SCHROCK RD STE 400
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-1174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-378-4827
-----------------------------------------------------
Fax | 800-222-8164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR REVENUE CYCLE
-----------------------------------------------------
Name | KAREN SHEPHERD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-378-4827
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------