Provider Demographics
NPI:1679331490
Name:HEALTHSOURCE OF OHIO, INC.
Entity type:Organization
Organization Name:HEALTHSOURCE OF OHIO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRATHER II
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-707-4041
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-707-4041
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:957A CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-7907
Practice Address - Country:US
Practice Address - Phone:937-783-7111
Practice Address - Fax:937-783-7115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSOURCE OF OHIO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)