MEDICARE: HEALTHSOURCE OF OHIO, INC.

Medicare Provider Information

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)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH7473	OTHER	OH	RAILROAD MEDICARE

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

NPI Number	:	1942242284
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	:	100 RIVER VALLEY BLVD
Second Line	:
City	:	NEW RICHMOND
State	:	OH
Zip	:	45157-8566
Country	:	US
Telephone Number	:	513-553-3114
Fax Number	:	513-553-1032

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/18/2024

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax:

100 RIVER VALLEY BLVD
NEW RICHMOND, OH
45157-8566