Provider Demographics
NPI:1467150086
Name:EQUITAS HEALTH, INC
Entity type:Organization
Organization Name:EQUITAS HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-378-4827
Mailing Address - Street 1:1105 SCHROCK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1174
Mailing Address - Country:US
Mailing Address - Phone:833-378-4827
Mailing Address - Fax:800-222-8164
Practice Address - Street 1:636 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1306
Practice Address - Country:US
Practice Address - Phone:833-378-4827
Practice Address - Fax:800-222-8164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EQUITAS HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0020994Medicaid