Basic Information
| Provider Information | |||||||||
| NPI: | 1639621824 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INCARE HEALTH SOLUTIONS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WALK IN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7081 PALMER CT | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430177976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409144178 | ||||||||
| FaxNumber: | 7403862640 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 N LEXINGTON SPRINGMILL RD | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449063812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195280047 | ||||||||
| FaxNumber: | 4195280094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | ABBAS | ||||||||
| AuthorizedOfficialFirstName: | QAISAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING & HR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7409144178 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0281700 | 05 | OH | MEDICAID |