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NPI Code Detail

MEDICARE: CARESOURCE MANAGEMENT GROUP

MEDICARE: CARESOURCE MANAGEMENT GROUP
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
1302F00000XExclusive Provider Organization
2302R00000XHealth Maintenance Organization
3305S00000XPoint of Service

General Provider Information

NPI Number : 1477098986
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARESOURCE MANAGEMENT GROUP
Provider Business Mailing Address
First Line : 230 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-1263
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 230 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-1263
Country : US
Telephone Number : 937-224-3300
Fax Number :
Authorized Official
Title or Position : CEO
Name : PAMELA MORRIS
Credential :
Telephone Number : 937-531-2201
Provider Enumeration Date : 12/20/2016
Last Update Date : 12/20/2016

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Directions to “CARESOURCE MANAGEMENT GROUP ” Practice Location

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