| Healthsource Of Ohio, Inc. | |
|
1231 Columbus Ave Unit A1 Lebanon OH 45036-8195 | |
| (513) 696-4495 | |
| (513) 228-1236 |
| Full Name | Healthsource Of Ohio, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1231 Columbus Ave, Lebanon, Ohio |
| Authorized Official Name and Position | Joseph W Prather Ii (CEO) |
| Authorized Official Contact | 5137074041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource Of Ohio, Inc. 424 Wards Corner Rd Ste 200 Loveland OH 45140-6966 Ph: (513) 707-4041 | Healthsource Of Ohio, Inc. 1231 Columbus Ave Unit A1 Lebanon OH 45036-8195 Ph: (513) 696-4495 |
| NPI Number | 1841624350 |
|---|---|
| Provider Enumeration Date | 09/03/2013 |
| Last Update Date | 09/18/2024 |
| Medicare PECOS PAC ID | 2264328749 |
|---|---|
| Medicare Enrollment ID | O20131210000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841624350 | NPI | - | NPPES |
| 0103505 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Healthsource Of Ohio, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1231 Columbus Ave, Unit A 1, Lebanon, OH 45036 Phone: 513-696-4495 Fax: 513-228-1236 |