Provider Demographics
NPI:1164859948
Name:HEALTHSPAN INTEGRATED CARE
Entity Type:Organization
Organization Name:HEALTHSPAN INTEGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOWISKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-639-2722
Mailing Address - Street 1:615 ELSINORE PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1459
Mailing Address - Country:US
Mailing Address - Phone:513-639-2722
Mailing Address - Fax:
Practice Address - Street 1:2500 STATE ROUTE 59
Practice Address - Street 2:SUITE 28
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7105
Practice Address - Country:US
Practice Address - Phone:216-265-8810
Practice Address - Fax:216-265-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty