=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891009502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHSOURCE OF OHIO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2010
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 HOSPITAL DR
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-0700
-----------------------------------------------------
Fax | 513-732-0642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 HOSPITAL DR SUITE 130
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-0700
-----------------------------------------------------
Fax | 513-732-0642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOSEPH W PRATHER II
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 513-707-4041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 02-2076650
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------