Provider Demographics
NPI:1275714289
Name:HEART OF OHIO FAMILY HEALTH CENTERS
Entity Type:Organization
Organization Name:HEART OF OHIO FAMILY HEALTH CENTERS
Other - Org Name:CAPITAL PARK FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-235-5555
Mailing Address - Street 1:PO BOX 632127
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2127
Mailing Address - Country:US
Mailing Address - Phone:614-235-5555
Mailing Address - Fax:614-536-1994
Practice Address - Street 1:2365 INNIS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3730
Practice Address - Country:US
Practice Address - Phone:614-416-4325
Practice Address - Fax:614-416-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3618892Medicare PIN
OH3618891Medicare PIN