Provider Demographics
NPI:1255846515
Name:EQUITAS HEALTH, INC
Entity type:Organization
Organization Name:EQUITAS HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-378-4827
Mailing Address - Street 1:1105 SCHROCK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1174
Mailing Address - Country:US
Mailing Address - Phone:833-378-4827
Mailing Address - Fax:833-222-8164
Practice Address - Street 1:1222 S PATTERSON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2643
Practice Address - Country:US
Practice Address - Phone:833-378-4827
Practice Address - Fax:833-222-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH279161Medicaid