Provider Demographics
NPI:1154462893
Name:PHYSICIANS HEALTHSOURCE INC
Entity Type:Organization
Organization Name:PHYSICIANS HEALTHSOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-922-2204
Mailing Address - Street 1:3328 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5133
Mailing Address - Country:US
Mailing Address - Phone:513-922-1599
Mailing Address - Fax:513-347-2735
Practice Address - Street 1:3328 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5133
Practice Address - Country:US
Practice Address - Phone:513-922-1599
Practice Address - Fax:513-347-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2558558Medicaid
OHDA5064Medicare PIN
OH4805610001Medicare NSC
OH9304321Medicare PIN