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General NPI Number Information
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NPI Number | 1477098986
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Entity Type | Organization
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Legal Business Name | CARESOURCE MANAGEMENT GROUP
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 230 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45402-1263
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Country | US
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Telephone | 937-224-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45402-1263
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAMELA MORRIS
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Credential |
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Telephone | 937-531-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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