| Healthsource: Wilmington | |
|
140 W Main St Wilmington OH 45177-2239 | |
| (937) 481-2930 | |
| (937) 382-4717 |
| Full Name | Healthsource: Wilmington |
|---|---|
| Speciality | Clinic/Center |
| Location | 140 W Main St, Wilmington, Ohio |
| Authorized Official Name and Position | Joseph W Prather Ii (CEO) |
| Authorized Official Contact | 5137074041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource: Wilmington 424 Wards Corner Rd Ste 200 Loveland OH 45140-6966 Ph: (513) 707-4041 | Healthsource: Wilmington 140 W Main St Wilmington OH 45177-2239 Ph: (937) 481-2930 |
| NPI Number | 1417266537 |
|---|---|
| Provider Enumeration Date | 10/07/2010 |
| Last Update Date | 09/18/2024 |
| Medicare PECOS PAC ID | 2264328749 |
|---|---|
| Medicare Enrollment ID | O20120629000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417266537 | NPI | - | NPPES |
| 0068750 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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