Provider Demographics
NPI:1831156561
Name:MHSWO HEALTH VENTURES, INC.
Entity type:Organization
Organization Name:MHSWO HEALTH VENTURES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-328-7000
Mailing Address - Street 1:2200 N LIMESTONE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2665
Mailing Address - Country:US
Mailing Address - Phone:937-399-5303
Mailing Address - Fax:
Practice Address - Street 1:2200 N LIMESTONE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2665
Practice Address - Country:US
Practice Address - Phone:937-399-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MHSWO HEALTH VENTURES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9364181Medicare PIN