Provider Demographics
NPI:1003862343
Name:HEALTHSOURCE OF OHIO, INC.
Entity Type:Organization
Organization Name:HEALTHSOURCE OF OHIO, INC.
Other - Org Name:HEALTHSOURCE: BATAVIA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-7700
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 1:2055 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1946
Practice Address - Country:US
Practice Address - Phone:513-732-0870
Practice Address - Fax:513-732-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0827216Medicaid
OHCH7473OtherRAILROAD MEDICARE
OH0827216Medicaid