| Organization Name: | HEALTHSOURCE OF OHIO, INC. |
| NPI Number: | 1023112224 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM MAROIS (CFO) |
| Mailing Address: | 218 Stern Rd Seaman |
| State: | OH US |
| Postal Code: | 456799607 |
| Phone Number: | 9373861379 |
| Fax Number: | 9373861029 |
| NPI Enumeration Date: | 09/11/2006 |
| NPI Last Update Date: | 10/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |