MEDICARE: FIDELITY HEALTH CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104250430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDELITY HEALTH CARE INC

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-208-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MIAMI VALLEY DR
Second Line	:	SUITE 360
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4779
Country	:	US
Telephone Number	:	937-438-7355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	PAULA THOMPSON
Credential	:
Telephone Number	:	937-208-6461

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	02/17/2017

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