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	291U00000X	Clinical Medical Laboratory
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1619812039
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	:	513-576-7700
Fax Number	:	513-576-1020

Provider Business Practice Location Address
First Line	:	424 WARDS CORNER RD STE 110
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-6943
Country	:	US
Telephone Number	:	513-576-5024
Fax Number	:	513-576-5025

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	06/01/2026

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Directions to “HEALTHSOURCE OF OHIO INC ” Practice Location

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