Organization Name: | HEALTHSOURCE OF OHIO, INC. |
NPI Number: | 1164458717 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY PATTON (CEO) |
Mailing Address: | 308 Highland Ave. Washington Court House |
State: | OH US |
Postal Code: | 431603701 |
Phone Number: | 7403358608 |
Fax Number: | 7403350137 |
NPI Enumeration Date: | 06/24/2006 |
NPI Last Update Date: | 02/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |