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General NPI Number Information
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NPI Number | 1659611424
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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 | 02/15/2013
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 6131 CAMPUS LN
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City | CINCINNATI
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State | OH
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Zip | 45230-1601
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Country | US
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Telephone | 513-732-5088
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Fax | 513-231-2520
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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 | 513-707-4041
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Fax | 513-576-1020
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH W PRATHER II
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Credential | MD
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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 | 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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