MEDICARE: HEALTHSOURCE OF OHIO, 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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1316994072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSOURCE OF OHIO, INC.

Provider Business Mailing Address
First Line	:	424 WARDS CORNER RD STE 200
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-6966
Country	:	US
Telephone Number	:	513-707-4041
Fax Number	:	513-576-1020

Provider Business Practice Location Address
First Line	:	4627 AICHOLTZ RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1518
Country	:	US
Telephone Number	:	513-753-2820
Fax Number	:	513-753-2824

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH W PRATHER II
Credential	:	MD
Telephone Number	:	513-707-4041

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/18/2024

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