Provider Demographics
NPI:1841222155
Name:HEALTHSOURCE OF OHIO, INC.
Entity Type:Organization
Organization Name:HEALTHSOURCE OF OHIO, INC.
Other - Org Name:HEALTHSOURCE: RIPLEY
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 1:5400 DUPONT CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2793
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-707-5692
Practice Address - Street 1:14 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1101
Practice Address - Country:US
Practice Address - Phone:937-392-4381
Practice Address - Fax:937-392-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH7473OtherRAILRAOD MEDICARE
OH0824264Medicaid
OHCH7473OtherRAILRAOD MEDICARE